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Individual

FABIAN JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
3173 WASHINGTON AVE, BATON ROUGE, LA 70802-2178
(225) 778-7678
(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

Enumeration date
11/12/2019
Last updated
11/12/2019
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Product
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  • EDI platform