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General NPI Number Information
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NPI Number | 1255981296
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Entity Type | Individual
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Provider Name | TAMMARA JACKSON DPT
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Gender | Female
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 3385 AIRWAYS BLVD STE 219
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City | MEMPHIS
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State | TN
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Zip | 38116-3808
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Country | US
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Telephone | 901-205-9534
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Fax | 833-471-4041
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Provider Business Mailing Address
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Address Line | 6815 AUTUMNHILL LN
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City | MEMPHIS
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State | TN
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Zip | 38135-1646
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Country | US
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Telephone | 901-315-5803
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 6595
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 12169
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License Number State | TN
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