Individual
OMAR JACKSON SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1301 LENFANT SQ SE, WASHINGTON, DC 20020-6724
(202) 221-1929
Mailing address
1301 LENFANT SQ SE, WASHINGTON, DC 20020-6724
(202) 221-1929
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/10/2024
Last updated
06/10/2024
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