Provider Demographics
NPI:1629614946
Name:JACOBS, SALLY J
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:J
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ASHFORD RD.
Mailing Address - Street 2:
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377
Mailing Address - Country:US
Mailing Address - Phone:910-843-9277
Mailing Address - Fax:
Practice Address - Street 1:401 ASHFORD RD.
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377
Practice Address - Country:US
Practice Address - Phone:910-843-9277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider