MEDICARE: JACKSON CLINIC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	152W00000X	Optometrist
2	207RC0000X	Cardiovascular Disease Physician
3	103T00000X	Psychologist
4	207W00000X	Ophthalmology Physician
5	207V00000X	Obstetrics & Gynecology Physician
6	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
7	207RG0100X	Gastroenterology Physician
8	207RP1001X	Pulmonary Disease Physician
9	207RN0300X	Nephrology Physician
10	207RI0011X	Interventional Cardiology Physician
11	207Q00000X	Family Medicine Physician
12	207ND0101X	MOHS-Micrographic Surgery Physician
13	207RI0200X	Infectious Disease Physician
14	133V00000X	Registered Dietitian
15	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285629386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACKSON CLINIC PA

Provider Business Mailing Address
First Line	:	PO BOX 400
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38302-0400
Country	:	US
Telephone Number	:	731-423-8697
Fax Number	:	731-422-5743

Provider Business Practice Location Address
First Line	:	2863 HIGHWAY 45 BYP
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3618
Country	:	US
Telephone Number	:	731-664-1375
Fax Number	:	731-664-1378

Authorized Official
Title or Position	:	C.E.O.
Name	:	MARK ALLEN
Credential	:
Telephone Number	:	731-422-0203

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	09/10/2025

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1407637135 — ALEXANDRIA HEARN PRINCE FNP-C
Practice Location Address:

2863 HIGHWAY 45 BYP
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38305-3618

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1245237601 — DR. MARY L SCOTT M.D.
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2859 HIGHWAY 45 BYP
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38305-3618

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1518952514 — JAMES J DIFFEE MD
Practice Location Address:

2863 HIGHWAY 45 BYP
JACKSON, TN
38305-3618

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1134114150 — DAVID GAREY MD
Practice Location Address:

2863 HIGHWAY 45 BYP
JACKSON, TN
38305-3618

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1386639136 — MARY ELISABETH NEAL ANDERSON MD
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Directions to “JACKSON CLINIC PA ” Practice Location

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