Individual
ANITA LOUISE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4315 LUDGATE ST, LUMBERTON, NC 28358-2460
(910) 738-1919
(910) 738-1991
Mailing address
PO BOX 1046, LUMBERTON, NC 28359-1046
(910) 738-1919
(910) 738-1991
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
9700991
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0215Y
BCBS
NC
01
—
040013091
RAILROAD MEDICARE
NC
01
—
103883
UNITEDHEALTH CARE
NC
05
—
892015Y
—
NC
Enumeration date
06/21/2006
Last updated
12/13/2010
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