Individual
JACKIE L. TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
708 W FOREST AVE, JACKSON, TN 38301-3901
(731) 660-8759
(731) 660-8739
Mailing address
1804 HIGHWAY 45 BYP, SUITE 604, JACKSON, TN 38305-4436
(731) 660-8759
(731) 660-8739
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD18902
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3889596
—
TN
01
—
4072420
BCBS
—
Enumeration date
01/13/2006
Last updated
12/02/2007
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