Organization
DR. DANNY W JACKSON D.O. PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANNY JACKSON (OWNER)
(662) 873-4361
Entity
Organization
Contact information
Practice address
29 S FOURTH ST, ROLLING FORK, MS 39159-5146
(662) 873-4361
(662) 873-2921
Mailing address
PO BOX 520, ROLLING FORK, MS 39159-0520
(662) 873-4361
(662) 873-2921
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00116560
—
MS
Enumeration date
07/08/2006
Last updated
08/22/2020
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