Jackson, Otis

Jackson, Otis is an individual health care provider with primary practice located at 3311 Kimball Ave , Memphis TN 38111-3846. He recently has only one registered license in Behavioral Health & Social Service Providers / Adult Development & Aging, which is considered as his primary health care specialty. Jackson, Otis can be contacted via phone (901) 207-4662.

Contact Information

Primary practice address
3311 Kimball Ave Memphis TN 38111-3846
Phone: (901) 207-4662
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Adult Development & Aging 103TA0700X 1000000015105 Tennessee

Profile Details

NPI number 1053710681
LBN Legal business name Jackson, Otis
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 20th, 2014
Last updated Aug 20th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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