Provider Demographics
NPI:1669821401
Name:JACKSON, ARABA AMONU (MD)
Entity Type:Individual
Prefix:
First Name:ARABA
Middle Name:AMONU
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ARABA
Other - Middle Name:
Other - Last Name:AMONU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2800 S SHIRLINGTON RD STE 706
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-3602
Mailing Address - Country:US
Mailing Address - Phone:571-777-2430
Mailing Address - Fax:
Practice Address - Street 1:2800 S SHIRLINGTON RD STE 706
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-3602
Practice Address - Country:US
Practice Address - Phone:571-777-2430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101277808207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology