Individual
ANTHONY RASHAD JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
435 N 5TH ST, PHOENIX, AZ 85004-2157
(602) 827-2450
Mailing address
12806 W HEARN RD, EL MIRAGE, AZ 85335-7308
(404) 578-8572
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9352
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
06/03/2022
Last updated
10/17/2022
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