Individual
WAYNE JEFFERY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
50 LEROY ST, POTSDAM, NY 13676-1786
(315) 265-3300
Mailing address
50 LEROY ST, POTSDAM, NY 13676-1786
(315) 265-3300
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004496
NY
Other
Enumeration date
06/22/2005
Last updated
03/31/2021
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