Individual
CHARLES DAVID JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3380 N FUTRALL DR STE 1, FAYETTEVILLE, AR 72703
(479) 442-7322
(479) 442-7379
Mailing address
PO BOX 1523, FAYETTEVILLE, AR 72702-1523
(479) 571-6038
(479) 582-0222
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
C-6427
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113041001
—
AR
01
—
51110
AR BC/BS
AR
Enumeration date
06/16/2006
Last updated
12/29/2021
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