Individual
DR. DANNY WADE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
29 S FOURTH ST, ROLLING FORK, MS 39159-5146
(662) 873-4361
(662) 873-2921
Mailing address
PO BOX 520, ROLLING FORK, MS 39159-0520
(662) 873-4361
(662) 873-2921
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
09390
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00019909
—
MS
Enumeration date
07/12/2006
Last updated
01/21/2010
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