Individual
SAMUEL WESLEY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5215 N CALIFORNIA AVE FL 7, CHICAGO, IL 60625-7014
(718) 270-8867
Mailing address
5215 N CALIFORNIA AVE FL 7, CHICAGO, IL 60625-7014
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
169934
IL
Other
Enumeration date
04/09/2019
Last updated
11/26/2024
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