MEDICARE: LATASHA JACKSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant
2	253Z00000X	In Home Supportive Care Agency	HC7950	NC

General Provider Information

NPI Number	:	1205542107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATASHA JACKSON

Provider Business Mailing Address
First Line	:	5135 DEVERON ST STE B
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-7530
Country	:	US
Telephone Number	:	919-740-8056
Fax Number	:

Provider Business Practice Location Address
First Line	:	5135 DEVERON ST STE B
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-7530
Country	:	US
Telephone Number	:	252-406-0576
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2023
Last Update Date	:	06/01/2025

Similar Medicare Providers

1508012105 — LIVEWELL MEDICAL INC
Practice Location Address:

7530 WHITE HORSE ROAD , UNIT C
GREENVILLE, SC
29611-2000

Practice Phone: 864-246-5075
Practice Fax: 864-246-5085

1891646477 — AALIYAH FARLAND
Practice Location Address:

622 S MEMORIAL DR
GREENVILLE, NC
27834-2854

Practice Phone: 919-910-4001
Practice Fax:

1861959579 — DR. JASON WALGOS DNP
Practice Location Address:

2430 EMERALD PL STE 201
GREENVILLE, NC
27834-5743

Practice Phone: 252-752-2140
Practice Fax:

1700654092 — LAUREN HARRINGTON
Practice Location Address:

EAST CAROLINA UNIVERSITY COLLEGE OF NURSING , 600 MOYE BLVD
GREENVILLE, NC
27834

Practice Phone: 252-744-6358
Practice Fax:

1699711515 — DR. JAMES S OLEKSA MD
Practice Location Address:

2430 EMERALD PL STE 201
GREENVILLE, NC
27834-5743

Practice Phone: 252-752-2140
Practice Fax:

1740132976 — MELBA BENTON LPN
Practice Location Address:

622 S MEMORIAL DR
GREENVILLE, NC
27834-2854

Practice Phone: 888-473-0904
Practice Fax:

Directions to “ LATASHA JACKSON ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.