MEDICARE: DR. JOYCE MARIE JACKSON M.D.

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	208M00000X	Hospitalist Physician	S1780	TX
2	207Q00000X	Family Medicine Physician	S1780	TX

General Provider Information

NPI Number	:	1558716142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOYCE MARIE JACKSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 691989
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77269-1989
Country	:	US
Telephone Number	:	888-718-8186
Fax Number	:	832-327-7868

Provider Business Practice Location Address
First Line	:	6640 CYPRESSWOOD DR STE 200
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-7738
Country	:	US
Telephone Number	:	888-718-8186
Fax Number	:	832-327-7868

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

Provider Enumeration Date	:	05/02/2016
Last Update Date	:	11/24/2025

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