Individual
GERARD JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OWNER
Contact information
Practice address
3173 WASHINGTON AVE, BATON ROUGE, LA 70802-2178
(225) 614-8960
(225) 341-6825
Mailing address
3173 WASHINGTON AVE, BATON ROUGE, LA 70802-2178
(225) 778-7678
(225) 341-6825
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5399927
—
LA
Enumeration date
03/03/2023
Last updated
03/03/2023
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