Individual
DAVID STONE JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18663
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2005640000
—
WV
01
—
25848
MEDCOST
NC
01
—
45508
BCBS
NC
01
—
5145
PARTNERS
NC
01
—
5489254
AETNA
—
05
—
7311559
—
VA
05
—
8945508
—
NC
05
—
Q18663
—
SC
Enumeration date
12/02/2005
Last updated
03/25/2014
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