Provider Demographics
NPI:1790957017
Name:JACKSON MANAGEMENT SERVICES
Entity Type:Organization
Organization Name:JACKSON MANAGEMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:919-522-8635
Mailing Address - Street 1:1533 HAYWARDS HEATH LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3620
Mailing Address - Country:US
Mailing Address - Phone:919-931-2669
Mailing Address - Fax:
Practice Address - Street 1:1533 HAYWARDS HEATH LN
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3620
Practice Address - Country:US
Practice Address - Phone:919-931-2669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization