Individual
COURTNEY CAROL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-3330
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
20117
MS
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD.024754
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07858241
—
MS
05
—
1579645
—
LA
01
—
P00618858
RR MEDICARE
MS
Enumeration date
05/14/2008
Last updated
06/05/2013
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