Organization
BRIAN D. JACKSON, DPM, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN DOUGLAS JACKSON DPM (PRESIDENT)
(931) 380-0353
Entity
Organization
Contact information
Practice address
1215 HATCHER LN, COLUMBIA, TN 38401-3531
(931) 380-0353
Mailing address
1215 HATCHER LN, COLUMBIA, TN 38401-3531
(931) 380-0353
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
436
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2740069
UNITED HEALTHCARE
—
01
—
3352132
MEDICARE GROUP PIN
—
01
—
3414014
CIGNA
—
01
—
4042682
BLUE CROSS OF TN
—
01
—
480034585
RAILROAD MEDICARE
—
01
—
DC1001
RAILROAD MEDICARE GROUP
TN
Enumeration date
08/15/2007
Last updated
02/06/2008
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