Individual
MIA LEIGH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2191 9TH AVE N STE 120, ST PETERSBURG, FL 33713-7147
(727) 954-6519
(727) 954-6524
Mailing address
PO BOX 748817, ATLANTA, GA 30374-8817
(813) 286-0033
(813) 282-1806
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
002024
GA
2085R0202X
Diagnostic Radiology Physician
Primary
ME109939
FL
Other
Enumeration date
01/22/2008
Last updated
06/22/2023
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