Individual
KARL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1619 SUNNYACRES RD, COPLEY, OH 44321-2330
(330) 666-6954
Mailing address
1619 SUNNYACRES RD., COPLEY, OHIO, OH 44321
(330) 666-6954
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41-2272067
—
OH
Enumeration date
08/28/2016
Last updated
08/28/2016
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