Provider Demographics
NPI:1548571052
Name:JACKSON, ALICIA PINSON (DO)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:PINSON
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 REN MAR DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-3722
Mailing Address - Country:US
Mailing Address - Phone:615-746-0203
Mailing Address - Fax:615-746-0001
Practice Address - Street 1:254 REN MAR DR
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146-3722
Practice Address - Country:US
Practice Address - Phone:615-746-0203
Practice Address - Fax:615-746-0001
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO 0000002461207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine