Jackson, Theresa G

Jackson, Theresa G is an individual health care provider with primary practice located at 3640 High St Suite 2A, Portsmouth VA 23707-3213. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation. Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation is her primary health care specialty. Jackson, Theresa G can be contacted via phone (757) 397-6930.

Contact Information

Primary practice address
3640 High St Suite 2A Portsmouth VA 23707-3213
Phone: (757) 397-6930
Fax: (757) 397-4864
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 0101050002 Virginia
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 0101050002 Virginia

Profile Details

NPI number 1245239227
LBN Legal business name Jackson, Theresa G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 20th, 2005
Last updated Jul 10th, 2013 - about 13 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 1245239227 NPPES
Virginia MEDICAID 005602785
Virginia Other 080007399
Virginia Other P00799688

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