Provider Demographics
NPI:1114915394
Name:JOSEPH P JACKSON JR
Entity Type:Organization
Organization Name:JOSEPH P JACKSON JR
Other - Org Name:CAMDEN ORTHOPAEDIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:803-432-9300
Mailing Address - Street 1:507 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-3649
Mailing Address - Country:US
Mailing Address - Phone:803-432-9300
Mailing Address - Fax:803-432-9307
Practice Address - Street 1:507 WALNUT ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-3649
Practice Address - Country:US
Practice Address - Phone:803-432-9300
Practice Address - Fax:803-432-9307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0279Medicaid
SC3560Medicare PIN
SC0376230001Medicare NSC