Individual
DR. DAVID DEWITT JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
708 S SOUTH ST, STE 100, MT AIRY, NC 27030-4426
(336) 789-9176
(336) 786-3778
Mailing address
PO BOX 1267, MT AIRY, NC 27030-1267
(336) 786-4522
(336) 789-3025
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
18662
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1912995093
SURRY SURGICAL GROUP NPI
NC
05
—
8945509
—
NC
Enumeration date
06/21/2005
Last updated
10/29/2015
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