Provider Demographics
NPI:1396579066
Name:JACKSON, CURTIS D I
Entity type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:D
Last Name:JACKSON
Suffix:I
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 1:5931 MEDALLION DR E
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9059
Mailing Address - Country:US
Mailing Address - Phone:614-678-3049
Mailing Address - Fax:
Practice Address - Street 1:5931 MEDALLION DR E
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9059
Practice Address - Country:US
Practice Address - Phone:614-678-3049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide