Individual
DR. WILLIAM THOMAS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
131 MEDICAL PARK ROAD, SUITE 204, MOORESVILLE, NC 28117-8524
(704) 664-5633
(704) 664-5631
Mailing address
P.O. BOX 1350, MOORESVILLE, NC 28115-1350
(704) 799-3380
(704) 799-6315
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
2002-01368
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891321P
—
NC
Enumeration date
11/19/2005
Last updated
07/30/2008
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