Individual
ALTHEA J. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2510 E DUPONT RD, SUITE 100, FORT WAYNE, IN 46825-1600
(260) 490-9883
(260) 490-0064
Mailing address
1330 POWELL ST, SUITE 507, NORRISTOWN, PA 19401-3353
(610) 279-9003
(610) 270-2654
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01052580A
IN
207V00000X
Obstetrics & Gynecology Physician
MD040658E
PA
Other
Enumeration date
08/16/2005
Last updated
07/08/2007
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