Individual
LAVAR JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
820 ANNANDALE RD, MADISON, MS 39110-7827
(504) 250-1316
Mailing address
820 ANNANDALE RD, MADISON, MS 39110-7827
(504) 250-1316
Taxonomy
Speciality
Code
Description
License number
State
347E00000X
Transportation Broker
Primary
—
—
Other
Enumeration date
11/17/2020
Last updated
11/17/2020
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