Individual
LAURAN DEKEASE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10543 SOUTH CRATER ROAD, PETERSBURG, VA 23805
(804) 481-5259
Mailing address
10543 SOUTH CRATER ROAD, PETERSBURG, VA 23805
(804) 481-5259
Taxonomy
Speciality
Code
Description
License number
State
2083T0002X
Medical Toxicology (Preventive Medicine) Physician
Primary
1401115318
VA
Other
Enumeration date
04/22/2026
Last updated
04/22/2026
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