Individual
RICHARD TERRY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 NORTH STATE STREET, DEPARTMENT OF MEDICINE/DIVISION OF GENERAL INTERNAL MED, JACKSON, MS 39216-4500
(601) 984-5660
Mailing address
2500 NORTH STATE STREET, DIVISION OF GENERAL INTERNAL MEDICINE, JACKSON, MS 39216-4500
(601) 984-5660
(601) 984-6870
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
09623
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00013218
—
MS
01
—
P00462239
RAILROAD MEDICARE PTAN
MS
Enumeration date
07/10/2006
Last updated
04/09/2014
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