Provider Demographics
NPI:1588455521
Name:JACKSON, CHARLES ALEXANDER OUSBORNE JR
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALEXANDER OUSBORNE
Last Name:JACKSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 BLAIRWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MERIDIANVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35759-2056
Mailing Address - Country:US
Mailing Address - Phone:256-919-5062
Mailing Address - Fax:
Practice Address - Street 1:207 BLAIRWOOD CT
Practice Address - Street 2:
Practice Address - City:MERIDIANVILLE
Practice Address - State:AL
Practice Address - Zip Code:35759-2056
Practice Address - Country:US
Practice Address - Phone:256-919-5062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program