Individual
JACKSON M EWART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
903 N FRASER ST # A, GEORGETOWN, SC 29440-2879
(843) 527-1331
(843) 527-1332
Mailing address
PO BOX 1519, GEORGETOWN, SC 29442-1519
(843) 527-1331
(843) 527-1332
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
8834
SC
2086S0129X
Vascular Surgery Physician
Primary
8834
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
088345
—
SC
01
—
7399
MEDICARE GROUP PTAN
SC
Enumeration date
11/14/2007
Last updated
08/05/2020
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