Individual
JACKSON DERRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
616 CAMPUS DR STE 100, ABINGDON, VA 24210-9706
(276) 525-4487
Mailing address
225 MALLARD DR, CHAPIN, SC 29036-8265
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/01/2026
Last updated
04/01/2026
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