Jackson, Charles Bartlett

Jackson, Charles Bartlett is an individual health care provider with primary practice located at 355 S Madison Blvd Ste C1 , Roxboro NC 27573-5485. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Jackson, Charles Bartlett can be contacted via phone (336) 599-8366.

Contact Information

Primary practice address
355 S Madison Blvd Ste C1 Roxboro NC 27573-5485
Fax: (336) 322-6168
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X C007168 North Carolina
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 1513 North Carolina

Profile Details

NPI number 1003149048
LBN Legal business name Jackson, Charles Bartlett
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 9th, 2009
Last updated Sep 6th, 2015 - about 9 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 1003149048 NPPES
North Carolina MEDICAID 6112139

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