Individual
DR. BENJAMIN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
709 GREEN VALLEY RD, GREENSBORO, NC 27408-7019
(336) 890-2530
Mailing address
300 W 27TH ST, LUMBERTON, NC 28358-3075
(910) 272-1478
(910) 738-3730
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
2021-01092
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2018
Last updated
07/25/2022
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