Individual
MR. DAVID DWAYNE JACKSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
245 PEREGRINE WAY, BOSSIER CITY, LA 71112-2556
(318) 422-3993
Mailing address
245 PEREGRINE WAY, BOSSIER CITY, LA 71112-2556
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/03/2023
Last updated
01/03/2023
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