Individual
MR. MARCUS S JACKSON SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5615 SHELL RD, PENSACOLA, FL 32503-7825
(850) 791-6604
Mailing address
5615 SHELL RD, PENSACOLA, FL 32503-7825
(850) 791-6604
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/08/2020
Last updated
07/08/2020
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