Organization Name: | JACKSON MEDICAL |
NPI Number: | 1396051660 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES WILLIAM JACKSON (PHYSICIAN/OWNER) |
Mailing Address: | 222 Church St Dickson |
State: | TN US |
Postal Code: | 370551304 |
Phone Number: | 6154461124 |
Fax Number: | 6154463511 |
NPI Enumeration Date: | 08/25/2010 |
NPI Last Update Date: | 08/25/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | MD10781 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |