Individual
EDWARD CHARLES JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
38358 US 36, WARSAW, OH 43844
(740) 824-3615
Mailing address
38358 US 36 PO BOX 82, WARSAW, OH 43844
(740) 824-3615
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2821343
—
OH
Enumeration date
12/01/2020
Last updated
12/01/2020
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