Individual
PAYTON JACKSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
445 LEDYARD ST, DETROIT, MI 48201-2641
(313) 962-9446
(313) 962-6395
Mailing address
445 LEDYARD ST, DETROIT, MI 48201-2641
(313) 964-9446
(313) 962-6395
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
251S00000X
MI
Other
Enumeration date
03/08/2017
Last updated
03/08/2017
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