Jackson, Gloria M

Jackson, Gloria M is an individual health care provider with primary practice located at 222 Grafton Dr , Grafton VA 23692-2152. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Jackson, Gloria M can be contacted via phone (757) 898-7737.

Contact Information

Primary practice address
222 Grafton Dr Grafton VA 23692-2152
Phone: (757) 898-7737
Fax: (757) 898-8377
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 0101043609 Virginia

Profile Details

NPI number 1235123423
LBN Legal business name Jackson, Gloria M
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 2nd, 2005
Last updated Feb 7th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235123423 NPPES
Virginia MEDICAID 010158745
Virginia Other P00291647
Virginia Other 177855

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