Individual
RICHARD DEWITT JACKSON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
140 KIMEL PARK DR STE 101, WINSTON SALEM, NC 27103-6185
(336) 718-7280
(336) 718-7290
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(336) 277-1800
(336) 277-6981
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
2012-01968
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/09/2011
Last updated
10/25/2020
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