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General NPI Number Information
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NPI Number | 1407296775
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Entity Type | Individual
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Provider Name | DARRIN JACKSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/01/2013
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 1415 CORPORATE SQUARE DR STE A
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City | SLIDELL
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State | LA
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Zip | 70458-3151
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Country | US
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Telephone | 985-259-4854
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Fax | 855-807-4750
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Provider Business Mailing Address
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Address Line | 1415 CORPORATE SQUARE DR STE A
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City | SLIDELL
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State | LA
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Zip | 70458-3151
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Country | US
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Telephone | 985-259-4854
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Fax | 855-807-4750
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | T-2680
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 302304
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License Number State | LA
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