Individual
BILLY JEROME JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3225 AMANDA DR, DAYTON, OH 45406-1102
(937) 789-6646
Mailing address
3225 AMANDA DR, DAYTON, OH 45406-1102
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
RQ788849
OH
3747P1801X
Personal Care Attendant
—
OH
376J00000X
Homemaker
—
OH
Other
Enumeration date
01/05/2021
Last updated
01/05/2021
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