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Individual

GREGORY L JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MSW

Contact information

Practice address
342 W PROGRESS RD, PRENTISS, MS 39474-5221
(601) 543-5585
Mailing address
342 W PROGRESS RD, PRENTISS, MS 39474-5221
(601) 543-5585

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
002608
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
Q017979
TN
Enumeration date
02/20/2016
Last updated
02/20/2016
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Product
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