Individual
IRVIN CHARLES JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
327 EAST STREET, SHUBUTA, MS 39360
(601) 577-4018
Mailing address
PO BOX 62, SHUBUTA, MS 39360-0062
(601) 577-4018
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
8006822128
MS
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
08/18/2020
Last updated
09/02/2020
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