IndividualActive
Carl-Christian Jackson, MD
NPI 1235355173 · Pediatric Surgery Physician · Providence, RI
Provider details
- NPI number
- 1235355173
- Entity type
- Individual
- Primary specialty
- Pediatric Surgery PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- License
- A88272 (CA)
Practice location
2 Dudley St Ste 190
Providence, RI 02905-3248
Phone: (401) 228-0623
Fax: (401) 868-2319
Mailing address
15 Lasalle Square
Providence, RI 02903
Registry dates
- Enumerated
- 2007-04-18
- Last updated
- 2025-11-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.