Individual
JORGE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT ATC
Contact information
Practice address
2831 NEW HARTFORD RD, OWENSBORO, KY 42303
(270) 926-4100
Mailing address
2831 NEW HARTFORD RD., OWENSBORO, KY 42303
(270) 926-4100
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
2000034178
KY
Other
Enumeration date
12/26/2019
Last updated
12/26/2019
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