Individual
JACKSON LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8560 COOK ST, MT PLEASANT, NC 28124-7686
(704) 436-6521
(704) 436-9505
Mailing address
270 COPPERFIELD BLVD NE STE 202, CONCORD, NC 28025-2441
(704) 721-2060
(704) 789-2090
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
210563
NC
Other
Enumeration date
05/18/2015
Last updated
03/11/2021
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