Organization
JACKSON CLINIC PA
Active
Other names
Jackson Clinic PA Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
CARL E RUDD (ADMINISTRATOR)
(731) 422-0330
Entity
Organization
Contact information
Practice address
616 W FOREST AVE, JACKSON, TN 38301-3902
(731) 422-0330
(731) 422-0220
Mailing address
PO BOX 400, JACKSON, TN 38302-0400
(731) 423-8697
(731) 422-5743
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
0000003266
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44D0315448
CLIA
TN
Enumeration date
09/11/2006
Last updated
08/22/2020
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