Individual
JOSEPH A JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
865 W LAKE DR, MT AIRY, NC 27030-2157
(336) 719-6100
Mailing address
2000 FRONTIS PLAZA BLVD STE 200, ATTN FORSYTH MEDICAL GROUP, WINSTON SALEM, NC 27103-5616
(336) 277-2436
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18000
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8945516
—
NC
Enumeration date
02/06/2006
Last updated
07/08/2007
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