Organization
JACKSONVILLE DIGESTIVE DISEASES CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CLARITA Q ISSA (CORP SEC)
(910) 577-1444
Entity
Organization
Contact information
Practice address
224 MEMORIAL DR, SUITE A, JACKSONVILLE, NC 28546
(910) 577-1444
(910) 577-1001
Mailing address
224 MEMORIAL DR, SUITE A, JACKSONVILLE, NC 28546
(910) 577-1444
(910) 577-1001
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
22581
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45475
BC
NC
05
—
8945475
—
NC
Enumeration date
08/18/2006
Last updated
11/14/2007
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