Doctor Name: | DR. RICHARD EVAN JACKSON |
NPI Number: | 1457359770 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 15545 |
Business Practice Address: | 106 Pinnacle Dr Suite 107 Johnson City, TN - 376156602 |
Business Phone Number: | 4233287332 |
Business Fax Number: | 4232071222 |
Mailing Address: | 106 Pinnacle Dr, Suite 107 JOHNSON CITY |
State: | TN |
Postal Code: | 376156602 |
Phone Number: | 4233287332 |
Fax Number: | 4232071222 |
NPI Enumeration Date: | 07/11/2005 |
NPI Last Update Date: | 07/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2084A0401X |
License Number: | 15545 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Psychiatry & Neurology |
Taxonomy Specialization: | Addiction Medicine |
Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |