Individual
DR. MARY TALLMADGE JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
120 CORBETT CANYON RD, ARROYO GRANDE, CA 93420-5151
(805) 459-0529
(805) 474-8555
Mailing address
120 CORBETT CANYON RD, ARROYO GRANDE, CA 93420-5151
(805) 474-8518
(805) 474-8555
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
6198
HI
207V00000X
Obstetrics & Gynecology Physician
Primary
G56252
CA
Other
Enumeration date
12/22/2005
Last updated
02/16/2016
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