Individual
LONNIE JEROME JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
975 E 3RD ST, CHATTANOOGA, TN 37403-2173
(423) 778-7000
Mailing address
624 BELLE VISTA AVE, CHATTANOOGA, TN 37411-2801
(252) 373-6996
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
34168
TN
363L00000X
Nurse Practitioner
Primary
304943
NC
363L00000X
Nurse Practitioner
41251
TN
Other
Enumeration date
01/15/2026
Last updated
07/18/2026
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