Provider Demographics
NPI:1366503716
Name:JACKSON, TAMARA JOYCE (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:JOYCE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 W ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5718
Mailing Address - Country:US
Mailing Address - Phone:202-610-7173
Mailing Address - Fax:
Practice Address - Street 1:1328 W ST SE
Practice Address - Street 2:ANACOSTIA CLINIC
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5718
Practice Address - Country:US
Practice Address - Phone:202-610-7173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD30650208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics