Individual
MR. SAMUEL ROBERT JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 981-7000
Mailing address
719 ARBUTUS AVE SE, ROANOKE, VA 24014-2503
(404) 983-5673
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110006058
VA
Other
Enumeration date
02/02/2018
Last updated
02/02/2018
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