| NPI | 1003958117 |
|---|---|
| Doing Business As | DR. TIM JACKSON |
| Entity Type | Organization |
| Authorized Contact | TIMOTHY D JACKSON Owner 228-832-9933 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MS 14510) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2008-08-22 |