Individual
DR. AVERY MICHAEL JACKSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9400 S SAGINAW RD STE A, GRAND BLANC, MI 48439-9666
(810) 606-7200
(810) 606-7115
Mailing address
4620 GENESYS PKWY, GRAND BLANC, MI 48439-8067
(810) 606-7200
(810) 606-7115
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
AJ076974
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0993708
HEALTHPLUS OF MICHIGAN
MI
05
—
4568263
—
MI
Enumeration date
06/28/2006
Last updated
07/28/2023
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