Provider Demographics
NPI:1548778350
Name:JACKSON, LUCY MORROW
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:MORROW
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 WOODMONT BLVD APT G9
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3327
Mailing Address - Country:US
Mailing Address - Phone:334-315-0771
Mailing Address - Fax:
Practice Address - Street 1:920 WOODMONT BLVD APT G9
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3327
Practice Address - Country:US
Practice Address - Phone:334-315-0771
Practice Address - Fax:334-315-0771
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program