Provider Demographics
NPI:1083237846
Name:ADAMS, JACKSON NASH (MD)
Entity Type:Individual
Prefix:
First Name:JACKSON
Middle Name:NASH
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 DEL CASA DR
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1304
Mailing Address - Country:US
Mailing Address - Phone:415-246-5591
Mailing Address - Fax:
Practice Address - Street 1:1960 N OGDEN ST STE 400
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3670
Practice Address - Country:US
Practice Address - Phone:303-318-1540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
COTL.0008543390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program