Individual
ANDREW THOMAS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
081265
GA
207X00000X
Orthopaedic Surgery Physician
52399
SC
208D00000X
General Practice Physician
28038
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003209886A
—
GA
05
—
523990
—
SC
Enumeration date
03/03/2013
Last updated
10/24/2019
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