Healthcare Provider Details

I. General information

NPI: 1447208871
Provider Name (Legal Business Name): MARK T JACKSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CENTRE PARK DR
ASHEVILLE NC
28805-1262
US

IV. Provider business mailing address

500 CENTRE PARK DR
ASHEVILLE NC
28805-1262
US

V. Phone/Fax

Practice location:
  • Phone: 828-254-4337
  • Fax: 828-251-9240
Mailing address:
  • Phone: 828-254-4337
  • Fax: 828-251-9240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200201481
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: