Individual
SONIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
490 DUNLOP LN BLDG 2, CLARKSVILLE, TN 37040-5007
(931) 245-8100
Mailing address
PO BOX 3799, CLARKSVILLE, TN 37043-3799
(931) 245-7000
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
60534
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q042787
—
TN
Enumeration date
04/27/2015
Last updated
08/30/2022
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