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General NPI Number Information
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NPI Number | 1295222842
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Entity Type | Organization
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Legal Business Name | TONIA JACKSON MD
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 766 TENNESSEE AVE S
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City | PARSONS
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State | TN
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Zip | 38363-4607
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Country | US
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Telephone | 731-847-7778
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 366
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City | PARSONS
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State | TN
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Zip | 38363-0366
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Country | US
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Telephone | 731-847-7778
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | J MONTGOMERY
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Credential |
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Telephone | 731-847-7778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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