MEDICARE: JAMILL JACKSON

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver

General Provider Information

NPI Number	:	1356073274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMILL JACKSON

Provider Business Mailing Address
First Line	:	1026 WILLOUGHBY STATION BLVD
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-7580
Country	:	US
Telephone Number	:	615-681-4450
Fax Number	:

Provider Business Practice Location Address
First Line	:	1026 WILLOUGHBY STATION BLVD
Second Line	:
City	:	MOUNT JULIET
State	:	TN
Zip	:	37122-7580
Country	:	US
Telephone Number	:	615-681-4450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2022
Last Update Date	:	01/31/2024

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Directions to “ JAMILL JACKSON ” Practice Location

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