| Doctor Name: | MR. JONATHAN GEORGE JACKSON |
| NPI Number: | 1861754004 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RN |
| License Number: | RN0000-176430 |
| Business Practice Address: | 120 Stockton Rd Chuckey, TN - 376415900 |
| Business Phone Number: | 4235520996 |
| Business Fax Number: | |
| Mailing Address: | 120 Stockton Rd, CHUCKEY |
| State: | TN |
| Postal Code: | 376415900 |
| Phone Number: | 4235520996 |
| Fax Number: | |
| NPI Enumeration Date: | 06/13/2012 |
| NPI Last Update Date: | 06/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WM0705X |
| License Number: | RN0000-176430 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Medical-Surgical |
| Taxonomy Definition: | |