Individual
MISS KATRINA E JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSA, CSFA
Contact information
Practice address
500 MARTHA JEFFERSON DR, CHARLOTTESVILLE, VA 22911-4668
(434) 654-7200
Mailing address
115 WOOD DUCK PL APT 303, CHARLOTTESVILLE, VA 22902-8202
(757) 300-3428
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0136000370
VA
Other
Enumeration date
09/26/2022
Last updated
09/26/2022
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