# PATRICIA JACKSON MD, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952409567
- **Authorized official:** JAMES O THEIS (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (504) 349-2908

## Contact information

- **Practice address:** 1111 MEDICAL CENTER BLVD, SUITE N408, MARRERO, LA 70072
- **Practice address phone:** (504) 349-2908
- **Practice address fax:** (504) 378-0019
- **Mailing address:** 6019 CONSTANCE ST, NEW ORLEANS, LA 70118-5806
- **Mailing address phone:** (504) 349-2908
- **Mailing address fax:** (504) 378-0019

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 08/21/2018