Individual
DR. TRACY P JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2960 CAMINO DIABLO STE 105, WALNUT CREEK, CA 94597-3945
(800) 892-2695
Mailing address
719 THOMPSON LN STE 22209, NASHVILLE, TN 37204-4692
(615) 322-4311
(615) 322-9089
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
200300358
NC
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
42636
TN
207LP2900X
Pain Medicine (Anesthesiology) Physician
A97159
CA
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
200300358
NC
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
42636
TN
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
A97159
CA
Other
Enumeration date
08/19/2006
Last updated
10/10/2022
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