Organization
PODIATRY CLINIC OF JACKSON PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JUDY H HOLT (OFFICE ADM/OFFICE MGR)
(731) 427-5581
Entity
Organization
Contact information
Practice address
657 SKYLINE DR, STE A, JACKSON, TN 38301-3903
(731) 427-5581
(731) 427-8257
Mailing address
657 SKYLINE DR, STE A, JACKSON, TN 38301-3903
(731) 427-5581
(731) 427-8257
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
DPM213
TN
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
DPM213
TN
213ER0200X
Radiology Podiatrist
DPM213
TN
213ES0131X
Foot Surgery Podiatrist
DPM213
TN
Other
Enumeration date
06/23/2016
Last updated
10/04/2016
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