Individual
MR. JACKSON B AUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
701 MADISON AVE, MADISON, WV 25130-1669
(304) 369-1230
Mailing address
9336 S MOUNTAIN RD, POUND, VA 24279-4735
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2052
WV
Other
Enumeration date
07/18/2017
Last updated
07/18/2017
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