Individual
MR. OTIS JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3311 KIMBALL AVE, MEMPHIS, TN 38111-3846
(901) 207-4662
Mailing address
1092 CENTER RIDGE RD, COLLIERVILLE, TN 38017-9207
(901) 870-6847
(901) 854-9779
Taxonomy
Speciality
Code
Description
License number
State
103TA0700X
Adult Development & Aging Psychologist
Primary
1000000015105
TN
Other
Enumeration date
08/20/2014
Last updated
08/20/2014
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