Individual
DR. TATIANIE ALICIA JACKSON
Active
Individual
DR. TATIANIE ALICIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
278083
MA
2085N0904X
Nuclear Radiology Physician
Primary
MD470854
PA
2085R0202X
Diagnostic Radiology Physician
278083
MA
Other
Enumeration date
07/16/2012
Last updated
06/11/2024
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