Provider Demographics
NPI:1467695411
Name:JACKSON,, JOHN RUSHING JR (JOHN JACKSON, MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RUSHING
Last Name:JACKSON,
Suffix:JR
Gender:M
Credentials:JOHN JACKSON, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-4290
Mailing Address - Country:US
Mailing Address - Phone:601-583-6279
Mailing Address - Fax:
Practice Address - Street 1:410 6TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-4290
Practice Address - Country:US
Practice Address - Phone:601-583-6279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4686208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics