Individual
THAD JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1700 RING RD, ELIZABETHTOWN, KY 42701-9497
(270) 769-5551
Mailing address
1700 RING RD, ELIZABETHTOWN, KY 42701-9497
(270) 769-5551
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
34151
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64065444
—
KY
Enumeration date
05/04/2006
Last updated
05/25/2012
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