Individual
JERRY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7937 WESTMORELAND AVE, PARKVILLE, MD 21234-5435
(910) 528-2628
Mailing address
7937 WESTMORELAND AVE, PARKVILLE, MD 21234-5435
(910) 528-2628
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8121820487
—
MD
Enumeration date
03/23/2017
Last updated
03/23/2017
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