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General NPI Number Information
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NPI Number | 1982702155
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Entity Type | Individual
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Provider Name | JACKSON SCOTT THOMAS MD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 2124 14TH ST
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City | MERIDIAN
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State | MS
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Zip | 39301-4040
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Country | US
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Telephone | 601-553-6000
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Fax | 601-703-0124
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Provider Business Mailing Address
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Address Line | 965 RIDGE LAKE BLVD STE 315
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City | MEMPHIS
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State | TN
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Zip | 38120-9401
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Country | US
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Telephone | 877-348-1281
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Fax | 901-227-3206
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 15444
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License Number State | MS
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