Active NPI
Nathan Oscar Jackson, MD
- Psychiatry Physician
- Roxboro, NC
National Provider Identifier
1104860055
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 39955
- Practice address
- 355C S Madison Blvd
Roxboro, NC 27573-5464 - Phone
- (336) 599-8366
- Fax
- (336) 599-8366
- NPI assigned
- Jun 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 39955 | NC | Primary |
Addresses
Primary practice location
355C S Madison Blvd
Roxboro, NC 27573-5464
Mailing address
216 Chateau PL
Chapel Hill, NC 27516-8767
Phone (919) 968-6339
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8945696 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39955 | NC | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Freedom House Recovery Center, Inc. | Past | Accepting new patients | |
| Youth Development Corporation of America | Past | Accepting new patients | |
| Triumph LLC | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Chapel Hill, NC
- NPI 1548490378
-
- Clinical Social Worker
- Raleigh, NC
- NPI 1003961269
-
- Community/Behavioral Health Agency
- Henderson, NC
- NPI 1629023569
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1104860055",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "216 CHATEAU PL",
"city": "CHAPEL HILL",
"state": "NC",
"postal_code": "275168767",
"telephone_number": "919-968-6339",
"fax_number": "336-599-8366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "355C S MADISON BLVD",
"city": "ROXBORO",
"state": "NC",
"postal_code": "275735464",
"telephone_number": "336-599-8366",
"fax_number": "336-599-8366"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "NATHAN",
"middle_name": "OSCAR",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-15",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NC",
"license": "39955",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8945696",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roxboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.