Organization
GML PAIN MD PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFERNIKA JACKSON (PRACTICE MANAGER)
(502) 253-0505
Entity
Organization
Contact information
Practice address
11300 MAPLE BROOK DR, LOUISVILLE, KY 40241-2080
(502) 253-0505
(502) 253-0303
Mailing address
11300 MAPLE BROOK DR, LOUISVILLE, KY 40241-2080
(502) 253-0505
(502) 253-0303
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
07/27/2015
Last updated
10/08/2025
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