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NPI Code Detail

MEDICARE: CASEY GORDON JACKSON M.D.

MEDICARE: CASEY GORDON JACKSON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician41430TN

General Provider Information

NPI Number : 1104834555
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASEY GORDON JACKSON M.D.
Provider Business Mailing Address
First Line : 877 JEFFERSON AVE
Second Line : 5TH FLOOR ADAMS PAVILION
City : MEMPHIS
State : TN
Zip : 38103-2807
Country : US
Telephone Number : 901-515-4529
Fax Number : 901-515-4599
Provider Business Practice Location Address
First Line : 4095 AMERICAN WAY
Second Line :
City : MEMPHIS
State : TN
Zip : 38118-8339
Country : US
Telephone Number : 901-515-5000
Fax Number : 901-375-0982
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 07/08/2007

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Directions to “ CASEY GORDON JACKSON M.D.” Practice Location

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