Jackson, Staley Thomas

Jackson, Staley Thomas is an individual health care provider with primary practice located at 2934 N Elm St Ste B1 , Lumberton NC 28358-2986. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Jackson, Staley Thomas can be contacted via phone (910) 272-1175.

Contact Information

Primary practice address
2934 N Elm St Ste B1 Lumberton NC 28358-2986
Phone: (910) 272-1175
Fax: (910) 272-1176
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 38362 North Carolina

Profile Details

NPI number 1225091408
LBN Legal business name Jackson, Staley Thomas
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 10th, 2006
Last updated Nov 3rd, 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 1225091408 NPPES
North Carolina Other 45569 BCBS
North Carolina MEDICAID 7945569 BCBS

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