# CHARLES W JACKSON MD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851594006
- **Authorized official:** DR. CHARLES JACKSON M.D. (PRESIDENT)
- **Authorized official phone:** (714) 847-6545

## Contact information

- **Practice address:** 17122 BEACH BLVD, STE. 102, HUNTINGTON BEACH, CA 92647-5992
- **Practice address phone:** (714) 847-6545
- **Practice address fax:** (714) 847-6547
- **Mailing address:** PO BOX 7630, LAGUNA NIGUEL, CA 92607-7630
- **Mailing address phone:** (949) 643-3345
- **Mailing address fax:** (949) 643-3560

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | G35311 | CA | Yes |

## Other

- **Enumeration date:** 06/06/2007
- **Last updated:** 07/28/2010