Demarcus Jackson

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Practice address

938 Breedlove St
Memphis, TN 38107-4272

Phone

(901) 463-6940

NPI assigned

Sep 10, 2025

Last updated

Sep 10, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1757462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757462400000",
    "number": "1912888405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "938 BREEDLOVE ST",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381074272",
            "telephone_number": "901-463-6940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "938 BREEDLOVE ST",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381074272",
            "telephone_number": "901-463-6940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DEMARCUS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-09-10",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Biddie Ruth Jackson, B.P.S.
• Casey Gordon Jackson, M.D.
• Charity Nicole Jackson, BACHELORS
• Cheryl Jackson, DDS
• Corey T Jackson
• Etoshia Jackson, DNP, FNP-C
• Eulanda K Jackson, DPH
• Felisa Loyd Jackson
• James Scully Jackson, MD
• Janell Lennice C Jackson, PHARM D.

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Memphis, TN
• Providers in Memphis, TN by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.