Marcus Andrew Jackson Sr.
Individual provider Active NPI Driver · Clarksville, TN
NPI 1295553899 · NPPES record last updated Oct 1, 2024
Key facts
- NPI
- 1295553899
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- License
- 099456671 (TN)
- Practice address
- 3742 Meadow Ridge LN
Clarksville, TN 37040-5494 - Phone
- (931) 542-7777
- NPI assigned
- Oct 1, 2024
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 099456671 | TN | MD | Driver |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 099456671 | TN | Yes |
Addresses
Primary practice location
3742 Meadow Ridge LN
Clarksville, TN 37040-5494
Mailing address
3742 Meadow Ridge LN
Clarksville, TN 37040-5494
Phone (931) 542-7777
Other providers in Clarksville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.