Organization
JACKSON CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK ALLEN (C.E.O.)
(731) 422-0203
Entity
Organization
Contact information
Practice address
2863 HIGHWAY 45 BYP, JACKSON, TN 38305-3618
(731) 664-1375
(731) 664-1378
Mailing address
PO BOX 400, JACKSON, TN 38302-0400
(731) 423-8697
(731) 422-5743
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
133V00000X
Registered Dietitian
—
—
152W00000X
Optometrist
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207RN0300X
Nephrology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207W00000X
Ophthalmology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3370007
—
TN
Enumeration date
09/14/2005
Last updated
09/10/2025
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