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General NPI Number Information
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NPI Number | 1407107378
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Entity Type | Organization
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Legal Business Name | JACKSON AND MOOR, LLC
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Dates
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Enumeration Date | 10/01/2012
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 5055 MARYLAND WAY
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City | BRENTWOOD
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State | TN
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Zip | 37027-7664
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Country | US
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Telephone | 615-828-6968
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Fax |
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Provider Business Mailing Address
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Address Line | 2308D MEMORIAL BLVD
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City | SPRINGFIELD
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State | TN
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Zip | 37172-3929
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Country | US
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Telephone | 615-828-6968
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Fax |
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Authorized Official
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Title or Position | PART OWNER
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Name | DR. CHRIS JACKSON
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Credential | D.C.
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Telephone | 615-828-6968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | TN34600
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License Number State | TN
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