Individual
JACKSON V GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15 REGIONAL DR, PINEHURST, NC 28374-8850
(910) 255-4400
(910) 420-1608
Mailing address
205 PAGE RD, PINEHURST, NC 28374-8798
(910) 295-5511
(910) 420-1608
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
27189
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401871
EVERCARE
NC
01
—
110081949
PALMETTO GBA PROVIDER#
NC
01
—
35323
BC/BS NC PROVIDER#
NC
01
—
80140
MEDCOST PROVIDER#
NC
05
—
8935323
—
NC
01
—
FH1000130
FIRSTCAROLINACARE PROV.#
NC
01
—
Q27189
SC MEDICAID PROVIDER#
SC
Enumeration date
06/16/2006
Last updated
03/17/2016
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