Individual
CAROLYN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LDN
Contact information
Practice address
1139 YALE PL, CHARLOTTE, NC 28209-1437
(919) 358-4822
Mailing address
1139 YALE PL, CHARLOTTE, NC 28209-1437
(919) 358-4822
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
L004704
NC
Other
Enumeration date
08/27/2015
Last updated
08/27/2015
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