Organization
HORACE J JACKSON MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HORACE J JACKSON MD (PRESIDENT OWNER)
(804) 788-0556
Entity
Organization
Contact information
Practice address
464 MAIN STREET, WARSAW, VA 22572
(804) 788-0556
Mailing address
464 MAIN STREET, WARSAW, VA 22572
(804) 788-0556
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006954
ANTHEM
VA
05
—
006O49656
—
VA
Enumeration date
12/17/2008
Last updated
12/17/2008
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