Individual
GABRIELLE K. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1901 TATE SPRINGS RD, LYNCHBURG, VA 24501-1109
(434) 200-5895
(434) 200-7529
Mailing address
PO BOX 11646, LYNCHBURG, VA 24506-1646
(434) 200-5895
(434) 200-7529
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101231613
VA
208M00000X
Hospitalist Physician
Primary
0101231613
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010214769
VA PREMIER PROVIDER NUMBE
—
05
—
010214769
—
VA
01
—
186404
ANTHEM PROVIDER NUMBER
—
01
—
20-3639329
PCHP PROVIDER NUMBER
—
01
—
203639329
UNITED HEALTHCARE PROVIDE
—
01
—
203639329014
TRICARE PROVIDER NUMBER
—
01
—
329076
SOUTHERN HEALTH PROVIDER
—
01
—
55500
SENTARA/OPTIMA PROVIDER N
—
01
—
6122638001
CIGNA PROVIDER NUMBER
—
01
—
B5342
MEDCOST PROVIDER NUMBER
—
01
—
P00475085
MEDICARE RAILROAD CARRIER
VA
Enumeration date
06/30/2005
Last updated
02/28/2023
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