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Lasalle Jackson
NPI 1508331711 · on the registry since 2018
Practice
- Address
- 606 Walnut St
Port Gibson, MS 39150 - Phone
- (601) 529-0527
Registry record
- Primary taxonomy
- 172A00000X
172A00000X
- Licence states on file
- MS
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2018-10-04
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Mississippi