DR. CHARLES WEST JACOCKS IV (NPI# 1720051105) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720051105 |
| Entity Type | Individual |
| Full Name | DR. CHARLES WEST JACOCKS IV |
| Credential | MD |
| Practice Address |
2300 Ramsey St Rm 304-a Fayetteville NC 28301-3856 |
| Practice Telephone | 9104882120 |
| Mailing Telephone | 9104882120 |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2019-07-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
14114 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | 141144 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104321967 | Charles Edward Jacocks | Internal Medicine | 301 Fisher St, Biloxi, MS 39534-2508 | 2018-03-26 |
| Street Address |
2300 RAMSEY ST RM 304-A |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28301-3856 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134726219 | Jenna Michelle Odneal | Behavior Technician | 16915 Liverpool Pkwy. Suite B., Cornelius, NC 28301 | 2020-10-02 |
| 1790390094 | Jessica Shellman | Counselor | 408 Person St. Ste 103, Fayetteville, NC 28301 | 2020-09-14 |
| 1487205951 | Martha K Richardson | Technician | 720 Teachers Dr, Fayetteville, NC 28301 | 2019-09-25 |
| 1013568161 | Angela Rena Locklear | Counselor | 211 Lamon St, Fayeteville, NC 28301 | 2019-09-20 |
| 1619535747 | Teresa Wilson | Contractor | 1417 Canyionland Ct, Apt 209, Fayetteville, NC 28301 | 2019-06-04 |
| 1912461815 | Catherine Stevenson Nwogalanya | Community Health Worker | 1103 Hillsboro St., Fayetteville, NC 28301 | 2019-01-24 |
| 1811443187 | Michael Carroll | Counselor | 308 Peterson Place, Fayetteville, NC 28301 | 2016-08-28 |
| 1023499886 | Latifa Fedai | Nurse Practitioner | 380 Person Street, Fayettevill, NC 28301 | 2015-06-17 |
| 1265868939 | Aci Support Specialists | Community/Behavioral Health | 1725 Venna Drive, Fayetteville, NC 28301 | 2013-09-25 |
| 1871929547 | Aci Support Specialists | Day Training, Developmentally Disabled Services | 2820 Copenhagen Drive, Fayetteville, NC 28301 | 2013-09-25 |
| Find all providers in zip 28301 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831406677 | Hana Smith | Internal Medicine | 4101 Medical Center Dr Fl 2, Fayetteville, NY 13066-6600 | 2010-08-31 |
| 1689874166 | Ashu Dhanjal | Internal Medicine | 1695 E Rainforest Rd Ste 4, Fayetteville, AR 72703 | 2007-07-23 |
| 1902942931 | Agodichi U Nwosu | Internal Medicine | 3613b Raeford Rd, Fayetteville, NC 28304-2113 | 2007-01-29 |
| 1164591947 | Soliman A Soliman | Internal Medicine | 3211 N Northhills Blvd Ste 110, Fayetteville, AR 72703-5602 | 2006-11-07 |
| 1093759839 | Deepak K Parashara | Internal Medicine | 2460 N. Common Drive, Fayetteville, AR 72703 | 2006-06-15 |
| 1962460550 | Manesh Thomas | Internal Medicine | 3650 Cape Center Dr, Fayetteville, NC 28304-2139 | 2006-05-03 |
| 1811961683 | Martin E Bacon | Internal Medicine | 3634 Cape Center Drive, Fayetteville, NC 28304 | 2006-02-16 |
| 1154393080 | Brenda May-depaola | Internal Medicine | 3634 Cape Center Dr, Fayetteville, NC 28304-4406 | 2006-02-03 |
| 1154305704 | Carolina Heart Physicians Pllc | Internal Medicine | 3613 Raeford Rd, Suite B, Fayetteville, NC 28304-2113 | 2005-12-06 |
| 1619966249 | Muhammad A Paracha | Internal Medicine | 3656 Cape Center Dr, Fayetteville, NC 28304 | 2005-10-17 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 28301 |
Please comment or provide details below to improve the information on DR. CHARLES WEST JACOCKS IV.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.