Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MR. OTIS JACKSON JR.
ActiveMR. OTIS JACKSON JR. is a Adult Development & Aging Psychologist healthcare provider located in MEMPHIS, Tennessee. NPI 1053710681 is currently active in the NPPES registry. Verify at CMS.
Adult Development & Aging Psychologist · MEMPHIS, TN
Registration Details
- NPI Number
- 1053710681
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Aug 20, 2014 (12.01189743548 yrs)
- Last Updated
- Aug 20, 2014
- License
-
1000000015105 (TN)
Practice Information
- Address
-
3311 KIMBALL AVEMEMPHIS, TN, 381113846Browse TN providers · Browse ZIP 38111
- Phone
- 9012074662
- Primary Specialty
-
Adult Development & Aging Psychologist
103TA0700X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.