Individual
MR. MARCUS ANDREW JACKSON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3742 MEADOW RIDGE LN, CLARKSVILLE, TN 37040-5494
(931) 542-7777
Mailing address
3742 MEADOW RIDGE LN, CLARKSVILLE, TN 37040-5494
(931) 542-7777
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
099456671
TN
Other
Enumeration date
10/01/2024
Last updated
10/01/2024
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