Individual
JOHNNY JACKSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6570 SOSNA DR, FAIRFIELD, OH 45014-2222
(513) 942-4673
(513) 860-1439
Mailing address
100 CROWNE POINT PL, CINCINNATI, OH 45241-5427
(513) 743-7628
(513) 737-1107
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
175T00000X
Peer Specialist
Primary
APS.004453
OH
Other
Enumeration date
10/03/2023
Last updated
11/16/2023
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