Active NPI
William Thomas Jackson, M.D.
- Orthopaedic Surgery Physician
- Mooresville, NC
National Provider Identifier
1700868106
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 2002-01368
- Practice address
- 131 Medical Park Road
Suite 204
Mooresville, NC 28117-8524 - Phone
- (704) 664-5633
- Fax
- (704) 664-5631
- NPI assigned
- Nov 19, 2005
- Last updated
- Jul 30, 2008
- 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 |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 2002-01368 | NC | Primary |
Addresses
Primary practice location
131 Medical Park Road
Suite 204
Mooresville, NC 28117-8524
Mailing address
P.O. Box 1350
Mooresville, NC 28115-1350
Phone (704) 799-3380
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 891321P | 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 |
|---|---|---|---|
| 01368 | NC | MD | Family Medicine Physician |
| 2002-01368 | NC | MD | Orthopaedic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217376000000",
"number": "1700868106",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 1350",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281151350",
"telephone_number": "704-799-3380",
"fax_number": "704-799-6315"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "131 MEDICAL PARK ROAD",
"address_2": "SUITE 204",
"city": "MOORESVILLE",
"state": "NC",
"postal_code": "281178524",
"telephone_number": "704-664-5633",
"fax_number": "704-664-5631"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "WILLIAM",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-19",
"last_updated": "2008-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "NC",
"license": "2002-01368",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "891321P",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mooresville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.