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Organization
DENA W. JACKSON, M.D.
Active
Organization
DENA W. JACKSON, M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE M PRICE (OFFICE MANAGER)
(601) 835-0507
Entity
Organization
Contact information
Practice address
527 SILVER CROSS DR, BROOKHAVEN, MS 39601-2388
(601) 835-0507
(601) 835-2766
Mailing address
PO BOX 4197, BROOKHAVEN, MS 39603-6197
(601) 835-0507
(601) 835-2766
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015702
—
MS
Enumeration date
08/30/2006
Last updated
08/22/2020
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