Individual
ROBERT E JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
517 CHESNEE HWY STE A, GAFFNEY, SC 29341-2709
(864) 487-7655
(864) 487-7818
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10879
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018797
—
SC
01
—
080075169
RR MCR
—
01
—
SCG5856067
MEDICARE PIN
SC
01
—
SCG5856084
MEDICARE PIN
SC
01
—
SCG585J577
MEDICARE PIN
SC
Enumeration date
01/03/2006
Last updated
01/21/2021
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