Individual
PAUL D JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
508 ARNOLD AVE, GREENVILLE, MS 38701-5319
(662) 335-4000
(662) 332-3867
Mailing address
PO BOX 23998, JACKSON, MS 39225-3998
(662) 725-2749
(662) 725-2741
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
09542
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00011234
—
MS
05
—
1528005
—
LA
01
—
P00386728
RR MEDICARE
—
Enumeration date
08/10/2006
Last updated
09/26/2007
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