Organization
GREATER CAROLINA EAR NOSE &THROAT P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANITA LOUISE JACKSON M.D., M.P.H (OWNER)
(910) 738-1919
Entity
Organization
Contact information
Practice address
4315 LUDGATE ST, LUMBERTON, NC 28358-2460
(910) 738-1919
(910) 738-1991
Mailing address
4315 LUDGATE STREET, LUMBERTON, NC 28358-2460
(910) 738-1919
(910) 738-1991
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0215Y
BCBS
NC
01
—
103883
UNITEDHEALTHCARE
NC
05
—
890215Y
—
NC
01
—
DQ4495
RAILROAD MEDICARE
NC
Enumeration date
10/17/2006
Last updated
07/21/2022
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