Derrell Glenn Jackson, PA-C

NPI #1104072297 in Colonial Heights, Virginia

Provider Information

NPI Number: 1104072297
Entity Type: Individual
Name: Derrell Glenn Jackson, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Aug 8, 2008
Last Updated: May 26, 2010

Practice Location

Address: 436 CLAREMONT CT
Address 2: SUITE 100
City: Colonial Heights
State: Virginia
ZIP Code: 23834-1765
Phone: (804) 526-2121

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant - Medical — Medical	363AM0700X
Physician Assistant	363A00000X	Primary

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