Jacksonville Digestive Diseases Clinic PA

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

22581 Issued in NC

Legal business name

JACKSONVILLE DIGESTIVE DISEASES CLINIC PA

Practice address

224 Memorial Dr
Suite a
Jacksonville, NC 28546

Phone

(910) 577-1444

Fax

(910) 577-1001

NPI assigned

Aug 18, 2006

Last updated

Nov 14, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Clarita Q Issa

Title

Corp Sec

Phone

(910) 577-1444

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194998400000",
    "number": "1861506545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 MEMORIAL DR",
            "address_2": "SUITE A",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "28546",
            "telephone_number": "910-577-1444",
            "fax_number": "910-577-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 MEMORIAL DR",
            "address_2": "SUITE A",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "28546",
            "telephone_number": "910-577-1444",
            "fax_number": "910-577-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSONVILLE DIGESTIVE DISEASES CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2007-11-14",
        "status": "A",
        "authorized_official_last_name": "ISSA",
        "authorized_official_first_name": "CLARITA",
        "authorized_official_middle_name": "Q",
        "authorized_official_title_or_position": "CORP SEC",
        "authorized_official_telephone_number": "910-577-1444",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NC",
            "license": "22581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8945475",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC",
            "identifier": "45475",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jacksonville Optical Co. Inc.
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• Gastroenterology Physician in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Gastroenterology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.