Joseph A Jackson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

18000 Issued in NC

Practice address

865 W Lake Dr
Mt Airy, NC 27030-2157

Phone

(336) 719-6100

NPI assigned

Feb 6, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962474676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 FRONTIS PLAZA BLVD STE 200",
            "address_2": "ATTN FORSYTH MEDICAL GROUP",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271035616",
            "telephone_number": "336-277-2436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "865 W LAKE DR",
            "city": "MT AIRY",
            "state": "NC",
            "postal_code": "270302157",
            "telephone_number": "336-719-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JOSEPH",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "18000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8945516",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carl Anthony Hutton, PA
• Innovative Meds RX (Gates Pharmacy)
• Innovative Meds RX (Gates Pharmacy LTC)
• Instride Foot & Ankle Specialists, PLLC
• David Dewitt Jackson, MD
• Kellie Suzanne Jackson, RN
• Linda Cheryl Jacobs, LPC
• Nina Jagust, MPT
• James H. Wells, D.D.S., P.a.
• Darla L Jefferson, LPTA

• Family Medicine Physician in Mount Airy, NC
• Providers in Mount Airy, NC by specialty
• Family Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.