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1114480001
SAMUEL WESLEY JACKSON
CHICAGO, IL
NPI
1114480001
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2084P0800X Psychiatry & Neurology, Psychiatry
(Licence: IL 169934)
Enumeration Date
2019-04-09
Last Update Date
2024-11-26
Business Address
SAMUEL WESLEY JACKSON MD
5215 N CALIFORNIA AVE FL 7
CHICAGO, IL 60625-7014
Phone number: 718-270-8867
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Mailing Address
SAMUEL WESLEY JACKSON MD
5215 N CALIFORNIA AVE FL 7
CHICAGO, IL 60625-7014
Phone number:
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