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Individual

CHRISTOPHER L JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2100 HIGHWAY 61 N, VICKSBURG, MS 39183-8211
(601) 883-5000
Mailing address
PO BOX 1198, DEPT 03-007RC, VICKSBURG, MS 39181-1198
(601) 883-4250

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
16463
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00121439
MS
05
1458392
LA
Enumeration date
06/08/2006
Last updated
02/05/2009
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