Healthcare Provider Details

I. General information

NPI: 1821141219
Provider Name (Legal Business Name): WILLIAM G JACKSON, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 03/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 TOLL RD UNIT B
SALISBURY MA
01952-1435
US

IV. Provider business mailing address

46 TOLL RD UNIT B
SALISBURY MA
01952-1435
US

V. Phone/Fax

Practice location:
  • Phone: 978-462-3009
  • Fax: 978-462-0177
Mailing address:
  • Phone: 978-462-3009
  • Fax: 978-462-0177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number57551
License Number StateMA

VIII. Authorized Official

Name: DR. WILLIAM G. JACKSON
Title or Position: OWNER
Credential: M.D.
Phone: 978-462-3009