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Individual
DR. TRACY P JACKSON
Active
Individual
DR. TRACY P JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
200300358
NC
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
42636
TN
207LP2900X
Pain Medicine (Anesthesiology) Physician
A97159
CA
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
200300358
NC
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
42636
TN
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
A97159
CA
Other
Enumeration date
08/19/2006
Last updated
10/10/2022
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