Organization
JAMES JACKSON, MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAWANA HILL (CREDENTIALING SPECIALIST)
(405) 896-7901
Entity
Organization
Contact information
Practice address
3330 NW 56TH ST STE 612, OKLAHOMA CITY, OK 73112-4470
(405) 610-8810
Mailing address
13924 QUAIL POINTE DR STE B, OKLAHOMA CITY, OK 73134-1024
(405) 896-7901
(405) 242-4074
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
27258
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2019800000X
—
OK
05
—
202K00000X
—
OK
Enumeration date
04/19/2018
Last updated
04/19/2018
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