Lasalle Jackson

NPI #1508331711 in Port Gibson, Mississippi

Provider Information

NPI Number: 1508331711
Entity Type: Individual
Name: Lasalle Jackson
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Driver
Enumeration Date: Oct 4, 2018
Last Updated: Oct 4, 2018

Practice Location

Address: 606 WALNUT ST
City: Port Gibson
State: Mississippi
ZIP Code: 39150-2140
Phone: (601) 529-0527

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Driver	172A00000X	Primary

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