Individual
DR. JOSEPH P JACKSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
507 WALNUT ST, CAMDEN, SC 29020-3649
(803) 432-9300
(803) 432-9307
Mailing address
507 WALNUT ST, CAMDEN, SC 29020-3649
(803) 432-9300
(803) 432-9307
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
7447
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010026253
RAILROAD MEDICARE
SC
05
—
GP0279
—
SC
Enumeration date
06/22/2005
Last updated
05/21/2008
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