Organization
GRACE E. JACKSON, MD, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACE E JACKSON MD (CEO)
(928) 649-6736
Entity
Organization
Contact information
Practice address
115 S CANDY LN STE C2, COTTONWOOD, AZ 86326-4188
(928) 649-6736
Mailing address
115 S CANDY LN STE C2, COTTONWOOD, AZ 86326-4188
(928) 649-6736
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
46710
AZ
Other
Enumeration date
09/11/2014
Last updated
10/14/2014
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