Joseph P Jackson Jr., M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

7447 Issued in SC

Practice address

507 Walnut St
Camden, SC 29020-3649

Phone

(803) 432-9300

Fax

(803) 432-9307

NPI assigned

Jun 22, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211328000000",
    "number": "1790781177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 WALNUT ST",
            "city": "CAMDEN",
            "state": "SC",
            "postal_code": "290203649",
            "telephone_number": "803-432-9300",
            "fax_number": "803-432-9307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 WALNUT ST",
            "city": "CAMDEN",
            "state": "SC",
            "postal_code": "290203649",
            "telephone_number": "803-432-9300",
            "fax_number": "803-432-9307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JOSEPH",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2008-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "SC",
            "license": "7447",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "010026253",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP0279",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laura Hooks
• Timothy Douglas Hornsby, DPT
• Randal Huber Jr., PTA
• Glenda Hucks, RPH
• Henry William Hulteen Jr., D.C.
• Charisa Nicole Jefferson, MSW
• Brittany Bradley Johnson, LPC
• Katherine L Johnson, PHARMD
• Tita Johnson
• Kaitlyn Jones

• Specialist in Camden, SC
• Providers in Camden, SC by specialty
• Specialist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.