Individual
DENA W JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
940 BROOKWAY BLVD, BROOKHAVEN, MS 39601-2644
(601) 823-5000
(601) 823-4140
Mailing address
940 BROOKWAY BLVD, BROOKHAVEN, MS 39601-2644
(601) 823-5000
(601) 823-4140
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15989
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124165
—
MS
01
—
P01402452
RR MEDICARE
MS
Enumeration date
08/30/2006
Last updated
11/11/2016
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