Individual
MR. RONNIE LEE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 NORTHCREST DR, SPRINGFIELD, TN 37172-3927
(615) 384-2411
Mailing address
100 NORTHCREST DR, SPRINGFIELD, TN 37172-3927
(615) 384-2411
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
MD020868
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3077609
—
TN
Enumeration date
12/22/2005
Last updated
12/14/2015
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