MEDICARE: JOSEPH P JACKSON JR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114915394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH P JACKSON JR

Provider Business Mailing Address
First Line	:	507 WALNUT ST
Second Line	:
City	:	CAMDEN
State	:	SC
Zip	:	29020-3649
Country	:	US
Telephone Number	:	803-432-9300
Fax Number	:	803-432-9307

Provider Business Practice Location Address
First Line	:	507 WALNUT ST
Second Line	:
City	:	CAMDEN
State	:	SC
Zip	:	29020-3649
Country	:	US
Telephone Number	:	803-432-9300
Fax Number	:	803-432-9307

Authorized Official
Title or Position	:	M.D.
Name	:	JOSEPH P JACKSON JR.
Credential	:	M.D.
Telephone Number	:	803-432-9300

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	06/11/2008

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