Clark, Juliana Jackson

Clark, Juliana Jackson is an individual health care provider with primary practice located at 2406 Blue Ridge Rd Suite 100, Raleigh NC 27607-6678. She recently has only one registered license in Allopathic & Osteopathic Physicians / Adolescent Medicine, which is considered as her primary health care specialty. Clark, Juliana Jackson can be contacted via phone (919) 786-5001.

Contact Information

Primary practice address
2406 Blue Ridge Rd Suite 100 Raleigh NC 27607-6678
Phone: (919) 786-5001
Fax: (919) 786-5051
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adolescent Medicine 2080A0000X 200300622 North Carolina

Profile Details

NPI number 1982675344
LBN Legal business name Clark, Juliana Jackson
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 1st, 2006
Last updated Jul 8th, 2007 - about 17 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 1982675344 NPPES
North Carolina MEDICAID 89138NX
North Carolina Other 138NX

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