Organization
OLD HICKORY MEDICAL LLC
Active
Organization
OLD HICKORY MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILBERT JEROME JACKSON (PRESIDENT)
(615) 668-9145
Entity
Organization
Contact information
Practice address
6841 SUNNYWOOD DR, NASHVILLE, TN 37211-8559
(615) 668-9145
Mailing address
6841 SUNNYWOOD DR, NASHVILLE, TN 37211-8559
(615) 668-9145
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
12/02/2008
Last updated
12/02/2008
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