Individual
DEMARCUS JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
938 BREEDLOVE ST, MEMPHIS, TN 38107-4272
(901) 463-6940
Mailing address
938 BREEDLOVE ST, MEMPHIS, TN 38107-4272
(901) 463-6940
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
TN
Other
Enumeration date
09/10/2025
Last updated
09/10/2025
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