Healthcare Provider Details

I. General information

NPI: 1386553022
Provider Name (Legal Business Name): MR. JAMES EDWARD JACKSON III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4389 E OLD SPRING HOPE RD
ROCKY MOUNT NC
27804-8008
US

IV. Provider business mailing address

4389 E OLD SPRING HOPE RD
ROCKY MOUNT NC
27804-8008
US

V. Phone/Fax

Practice location:
  • Phone: 919-703-7358
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number304812
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: