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General NPI Number Information
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NPI Number | 1336162718
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Entity Type | Organization
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Legal Business Name | WILLIAM G. JACKSON, M.D.,P.A.
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 11/05/2010
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Provider Practice Location Address
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Address Line | 202 ALCORN DR
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City | CORINTH
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State | MS
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Zip | 38834-9701
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Country | US
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Telephone | 662-287-4481
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Fax | 662-287-4368
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Provider Business Mailing Address
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Address Line | 202 ALCORN DR
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City | CORINTH
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State | MS
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Zip | 38834-9701
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Country | US
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Telephone | 662-287-4481
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Fax | 662-287-4368
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | WILLIAM JACKSON
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Credential |
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Telephone | 662-287-4481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 07322
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License Number State | MS
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