Organization
PHILLIP COREY JACKSON, MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILLIP COREY JACKSON M.D. (OWNER)
(870) 741-0016
Entity
Organization
Contact information
Practice address
1417 GLADDEN ST, HARRISON, AR 72601-5121
(870) 741-0016
(870) 741-4242
Mailing address
1417 GLADDEN ST, HARRISON, AR 72601-5121
(870) 741-0016
(870) 741-4242
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E3074
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5F478
BLUE CROSS BLUE SHIELD
AR
Enumeration date
10/16/2007
Last updated
06/06/2014
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