Individual
DR. CHARLES ANDREW JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2263 HWY 65 NORTH, MARSHALL, AR 72650
(870) 448-5733
Mailing address
2263 HWY 65 NORTH, MARSHALL, AR 72650
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-0979
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080168260
RR MEDICARE
—
05
—
130077001
—
AR
Enumeration date
07/13/2006
Last updated
03/18/2021
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