Provider Demographics
NPI:1790724326
Name:JACKSON, SARAH CENAC (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:CENAC
Last Name:JACKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:LOUISE
Other - Last Name:CENAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3525 PRYTANIA ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3500
Mailing Address - Country:US
Mailing Address - Phone:504-895-3376
Mailing Address - Fax:504-910-3350
Practice Address - Street 1:3525 PRYTANIA ST
Practice Address - Street 2:SUITE 501
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3500
Practice Address - Country:US
Practice Address - Phone:504-895-3376
Practice Address - Fax:504-910-3350
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA026193207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1054691Medicaid