Individual
COREY N JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
130 MANKIN PL, LA VERGNE, TN 37086-3048
(931) 722-1443
Mailing address
130 MANKIN PL, LA VERGNE, TN 37086-3048
(931) 722-1443
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
—
—
Other
Enumeration date
01/03/2012
Last updated
01/03/2012
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