Provider Demographics
NPI:1467404343
Name:JACKSON, CARSWELL HOOTS (MD)
Entity type:Individual
Prefix:
First Name:CARSWELL
Middle Name:HOOTS
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 N ELM ST
Mailing Address - Street 2:SUITE 110A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2604
Mailing Address - Country:US
Mailing Address - Phone:336-282-4840
Mailing Address - Fax:336-282-4660
Practice Address - Street 1:2102 N ELM ST STE H1
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-5100
Practice Address - Country:US
Practice Address - Phone:336-808-5135
Practice Address - Fax:336-808-5388
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38781207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010102405Medicaid
NC45521OtherBCBS
NC8945521Medicaid
NC45521OtherBCBS
VA010102405Medicaid