DR. TIMOTHY D JACKSON MD, SA-C
NPI 1093710089
Specialist/Technologist, Other - Surgical Assistant in Gulfport, MS

Q: What is Timothy Jackson's NPI number?

The NPI number for Timothy Jackson is 1093710089. It was assigned to this individual provider in the NPPES registry on June 16, 2005.

Q: What is Timothy Jackson's specialty?

The primary specialty registered for this NPI is Specialist/Technologist, Other, specializing in Surgical Assistant, with taxonomy code 246ZC0007X.

Q: When was this NPI record last updated?

The NPPES record for Timothy Jackson was last updated on January 14, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 16, 2005

4500 13TH ST, GULFPORT, MS 39501(228) 304-9436 Get Directions Write a Review

NPPES record last updated: January 14, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 14, 2026, Jun 7, 2023, Mar 2, 2023 (3 updates tracked since 2023).

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About Dr. Timothy D Jackson Md, Sa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. TIMOTHY D JACKSON MD, SA-C (NPI 1093710089) is an individual surgical assistant in Gulfport, Mississippi, licensed in (19-516) and active in the NPI registry since June 2005.

NPPES Registry Identity

NPI1093710089

Entity TypeIndividualMale

Primary Taxonomy246ZC0007X

Provider Legal NameDR. TIMOTHY D JACKSONCredential: MD, SA-C

Location Address4500 13TH STGulfport, MS 39501-2515

Mailing Address15520 Daniel Blvd # 310Gulfport, MS 39503-4735 · (228) 304-9436

Phone(228) 304-9436

Sole ProprietorYes

Enumeration DateJune 16, 2005

Last NPPES UpdateJanuary 14, 20263 updates tracked since enumeration

NPPES CertifiedJanuary 14, 2026

✔ NPI 1093710089 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySpecialist/Technologist, Other · Surgical AssistantTechnologists, Technicians & Other Technical Service Providers

Taxonomy Code246ZC0007X

License✔ Licensed · 19-516

Definition

A surgical assistant is a skilled practitioner who has undergone formalized education and training as a surgical assistant. The surgical assistant performs surgical functions that include, but are not limited to: retracting, manipulating, suturing, clamping, cauterizing, litigating, and tying tissue; suctioning, irrigating and sponging; positioning the patient; closure of body planes and skin; and participating in hemostasis and volume replacement. Surgical assistants are certified and registered or licensed by the state, or, in states without licensure, certified as surgical assistants by completing appropriate education and training.

Also ListedOrthopaedic SurgeryTaxonomy 207X00000X · License 14510 (MS)

4500 13TH ST, Gulfport, MS 39501

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