Individual
DR. AMANDA KAY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
400 N STATE OF FRANKLIN RD, PEDIATRIC EMERGENCY DEPARTMENT, JOHNSON CITY, TN 37604-6035
(423) 431-5339
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
51518
TN
208000000X
Pediatrics Physician
01075191
IN
208000000X
Pediatrics Physician
MD0000051518
TN
Other
Enumeration date
05/09/2011
Last updated
06/01/2023
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