Individual
JOSEPH JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
119 ROBERTSON ST, OKOLONA, MS 38860-1620
(662) 447-3882
(662) 447-2265
Mailing address
119 ROBERTSON ST, OKOLONA, MS 38860-1620
(662) 447-3882
(662) 447-2265
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17430
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01371061
—
MS
Enumeration date
02/28/2006
Last updated
03/08/2011
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