Individual
DR. RICHARD EVAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
106 PINNACLE DR, SUITE 107, JOHNSON CITY, TN 37615-6602
(423) 328-7332
(423) 207-1222
Mailing address
106 PINNACLE DR, SUITE 107, JOHNSON CITY, TN 37615-6602
(423) 328-7332
(423) 207-1222
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
15545
TN
2084P0800X
Psychiatry Physician
Primary
15545
TN
Other
Enumeration date
07/11/2005
Last updated
07/17/2014
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