Provider Demographics
NPI:1487032827
Name:LONG, JACKSON (MD)
Entity Type:Individual
Prefix:
First Name:JACKSON
Middle Name:
Last Name:LONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:270 COPPERFIELD BLVD NE STE 202
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2441
Mailing Address - Country:US
Mailing Address - Phone:704-721-2060
Mailing Address - Fax:704-789-2090
Practice Address - Street 1:8560 COOK ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:NC
Practice Address - Zip Code:28124-7686
Practice Address - Country:US
Practice Address - Phone:704-436-6521
Practice Address - Fax:704-436-9505
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2021-03-11
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Provider Licenses
StateLicense IDTaxonomies
NC210563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine