Individual
DARRIN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1415 CORPORATE SQUARE DR STE A, SLIDELL, LA 70458-3151
(985) 259-4854
(855) 807-4750
Mailing address
1415 CORPORATE SQUARE DR STE A, SLIDELL, LA 70458-3151
(985) 259-4854
(855) 807-4750
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
302304
LA
207Q00000X
Family Medicine Physician
T-2680
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05427361
—
MS
05
—
2427806
—
LA
Enumeration date
07/01/2013
Last updated
07/26/2021
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