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General NPI Number Information
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NPI Number | 1407858368
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Entity Type | Individual
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Provider Name | WILLIAM CLAY JACKSON MD
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 09/24/2020
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Provider Practice Location Address
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Address Line | 7945 WOLF RIVER BLVD
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City | GERMANTOWN
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State | TN
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Zip | 38138-1762
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Country | US
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Telephone | 901-683-0055
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Fax | 901-685-2969
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Provider Business Mailing Address
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Address Line | 7714 POPLAR AVE STE 200
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City | GERMANTOWN
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State | TN
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Zip | 38138-3941
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Country | US
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Telephone | 901-683-0055
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Fax | 901-685-2969
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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 | 31696
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | 31696
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License Number State | TN
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