Provider Demographics
NPI:1245841303
Name:JACKSON, JEROME CHRISTOPHER
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:CHRISTOPHER
Last Name:JACKSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 CANAAN CIR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3536
Mailing Address - Country:US
Mailing Address - Phone:757-769-4649
Mailing Address - Fax:
Practice Address - Street 1:314 CANAAN CIR
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3536
Practice Address - Country:US
Practice Address - Phone:757-769-4649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)