Jackson, Woody H

Jackson, Woody H is an individual health care provider with primary practice located at 2131 S 17Th St , Wilmington NC 28401-7407. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Jackson, Woody H can be contacted via phone (910) 815-5830.

Contact Information

Primary practice address
2131 S 17Th St Wilmington NC 28401-7407
Phone: (910) 815-5830
Fax: (910) 815-5698
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD063122L Pennsylvania
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X MD063122L Pennsylvania

Profile Details

NPI number 1073587598
LBN Legal business name Jackson, Woody H
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 13th, 2006
Last updated Aug 19th, 2014 - about 10 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 1073587598 NPPES
North Carolina MEDICAID 5919880
North Carolina MEDICAID 001688698
North Carolina Other 232359401
North Carolina MEDICAID Q0029K

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