Individual
CAROL MACKENZIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
333 COTTMAN AVE, PHILADELPHIA, PA 19111-2434
(215) 728-6900
(215) 728-2773
Mailing address
3500 N. BROAD ST. ROOM 001A, PHILADELPHIA, PA 19140-4106
(215) 926-9022
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA052046
PA
Other
Enumeration date
05/16/2007
Last updated
12/01/2022
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