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NPI Code Detail

MEDICARE: JACKSON ROBERSON PA-C

MEDICARE: JACKSON ROBERSON PA-C
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
1363A00000XPhysician Assistant0010-15256NC

General Provider Information

NPI Number : 1821831223
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACKSON ROBERSON PA-C
Provider Business Mailing Address
First Line : 501 S SHARON AMITY RD STE 300
Second Line :
City : CHARLOTTE
State : NC
Zip : 28211-0035
Country : US
Telephone Number : 704-377-2424
Fax Number : 704-377-2687
Provider Business Practice Location Address
First Line : 501 S SHARON AMITY RD STE 300
Second Line :
City : CHARLOTTE
State : NC
Zip : 28211-0035
Country : US
Telephone Number : 704-377-2424
Fax Number : 704-377-2687
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2024
Last Update Date : 12/05/2025

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Directions to “ JACKSON ROBERSON PA-C” Practice Location

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