Individual
LATANYA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PBT
Contact information
Practice address
315 PROVIDENCE BLVD, CLARKSVILLE, TN 37042-4325
(615) 300-3724
Mailing address
1897 EISENHOWER RD, CLARKSVILLE, TN 37042-9583
(615) 300-3724
Taxonomy
Speciality
Code
Description
License number
State
246R00000X
Pathology Technician
Primary
67093
TN
Other
Enumeration date
12/12/2022
Last updated
12/12/2022
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