Individual
DR. JONATHAN KENTON TACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6330 QUADRANGLE DR STE 500, CHAPEL HILL, NC 27517-8281
(888) 849-7379
Mailing address
5640 MARBLEHEAD DR, COLFAX, NC 27235-9801
(501) 676-1410
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2019-01875
NC
207P00000X
Emergency Medicine Physician
E-10960
AR
207Q00000X
Family Medicine Physician
Primary
2019-01875
NC
207QG0300X
Geriatric Medicine (Family Medicine) Physician
2019-01875
NC
Other
Enumeration date
05/16/2016
Last updated
02/10/2023
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