Jackson, Thomas R

Jackson, Thomas R is an individual health care provider with primary practice located at 1100 Blythe Blvd , Charlotte NC 28203-5814. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation is his primary health care specialty. Jackson, Thomas R can be contacted via phone (704) 512-4808.

Contact Information

Primary practice address
1100 Blythe Blvd Charlotte NC 28203-5814
Phone: (704) 512-4808
Fax: (704) 512-4838
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X MT179687 Pennsylvania
Allopathic & Osteopathic Physicians / Pain Medicine 2081P2900X MD13171 Rhode Island
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X MD13171 Rhode Island
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 2011-00970 North Carolina

Profile Details

NPI number 1790765667
LBN Legal business name Jackson, Thomas R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 18th, 2006
Last updated Jan 27th, 2015 - about 11 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 1790765667 NPPES
North Carolina MEDICAID 5918134
North Carolina MEDICAID TJ79199
North Carolina MEDICAID 1790765667
North Carolina MEDICAID NC1445

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