Otis Jackson JR.

NPI 1053710681 - Psychologist - 103TA0700X

NPI Details
NPI 1053710681
Gender Male
Enumeration Date 08/20/2014
Last Updated 08/20/2014
Entity Type Individual
Active Over 2 years ago
Practice Location
3311 KIMBALL AVE
MEMPHIS TN, 38111-3846, US
Phone (901) 207-4662
Fax
Business Location
1092 CENTER RIDGE RD
COLLIERVILLE TN, 38017-9207, US
Phone (901) 870-6847
Fax (901) 854-9779
Toxanomy
Taxonomy Code 103TA0700X
License State Tennessee
License Number 1000000015105
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According to our database, Mr. Otis Jackson JR. NPI is 1053710681, taxonomy code is 103TA0700X and license number is 1000000015105, license state is located at Tennessee. Otis Jackson JR. physically located at 3311 Kimball Ave, Memphis TN, 38111-3846. NPI Number Otis Jackson JR. has the Individual type.

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1053710681 NPI number is provided on an as is basis without warranty of any kind. 1053710681 is maintained by the National Plan & Provider Enumeration System. The contents of Otis Jackson JR. are for informational purposes only.