Basic Information
| Provider Information | |||||||||
| NPI: | 1487701926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACKSON | ||||||||
| FirstName: | JOANN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1145 19TH ST NW | ||||||||
| Address2: | SUITE 410 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2023311740 | ||||||||
| FaxNumber: | 2022969784 | ||||||||
| Practice Location | |||||||||
| Address1: | 1145 19TH ST NW | ||||||||
| Address2: | #410 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2023311740 | ||||||||
| FaxNumber: | 2022969784 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | D0064418 | MD | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | MD036030 | DC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 0101238331 | VA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.