Individual
GARRETT J JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11104 PARKVIEW CIRCLE DR STE 110, FORT WAYNE, IN 46845-1673
(260) 425-6780
(260) 425-6615
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
01074880A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
WV
Other
Enumeration date
04/01/2009
Last updated
12/11/2025
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