Individual
NATHAN ANDREW MERL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
117 EXECUTIVE DR, DANVILLE, VA 24541-4101
(434) 792-0423
Mailing address
4545 RIVERSIDE DR STE D, DANVILLE, VA 24541-5173
(434) 792-0423
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
1376805821
VA
207Q00000X
Family Medicine Physician
OT014572
PA
Other
Enumeration date
06/11/2012
Last updated
10/19/2021
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