Jackson, Travis Harold
Jackson, Travis Harold is an individual health care provider with primary practice located at 145 Kimel Park Dr Suite 100, Winston-Salem NC 27103-6983. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Jackson, Travis Harold can be contacted via phone (336) 768-6347.Contact Information
Primary practice address
145 Kimel Park Dr Suite 100
Winston-Salem NC 27103-6983
Phone: (336) 768-6347
Fax: (336) 760-9393
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | 0000-20148 | North Carolina |
Profile Details
| NPI number | 1043256126 |
|---|---|
| LBN Legal business name | Jackson, Travis Harold |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 20th, 2006 |
| Last updated | Mar 4th, 2011 - about 14 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1043256126 | NPPES |
| North Carolina | MEDICAID | 8945571 | |
| North Carolina | Other | P00288396 |
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