Individual
ANDREW JACKSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1401 HUDSON LN, SUITE 202, MONROE, LA 71201-6068
(318) 570-5400
Mailing address
1401 HUDSON LN, SUITE 202, MONROE, LA 71201-6068
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306217062
MENTAL HEALTH
LA
Enumeration date
11/30/2016
Last updated
01/07/2019
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