Individual
KEVIN GABRIEL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6206 COUNTY ROAD 4511, ATHENS, TX 75752-5778
(903) 603-6863
Mailing address
6206 COUNTY ROAD 4511, ATHENS, TX 75752-5778
(903) 603-6863
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
29219719
TX
Other
Enumeration date
05/13/2021
Last updated
05/13/2021
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