MR. OTIS JACKSON JR. (NPI# 1053710681) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053710681 |
| Entity Type | Individual |
| Full Name | MR. OTIS JACKSON JR. |
| Practice Address |
3311 Kimball Ave Memphis TN 38111-3846 |
| Mailing Address |
1092 Center Ridge Rd Collierville TN 38017-9207 |
| Practice Telephone | 9012074662 |
| Mailing Telephone | 9018706847 |
| Mailing Fax Number | 9018549779 |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2014-08-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TA0700X |
Psychologist Specialization: Adult Development & Aging |
1000000015105 | TN | Behavioral Health & Social Service Providers |
| Street Address |
3311 KIMBALL AVE |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38111-3846 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841696101 | Wright Enhancement Center | Psychologist | 3311 Kimball Ave, Memphis, TN 38111-3846 | 2014-11-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982168035 | Meghan Weakley Pace | Occupational Therapist | 177 North Highlanld Ave, Memphis, TN 38111 | 2019-01-23 |
| 1386130466 | Christopher Cory Wilbanks | Nurse Practitioner | 3445 Poplar Ave Ste 18, Memphis, TN 38111 | 2018-07-02 |
| 1124523287 | Hands of Health and Rehab | Clinic/Center | 80 N. Tillman St. Ste. 104, Memphis, TN 38111 | 2018-03-29 |
| 1659889889 | Jarod Lenahan | Specialist/Technologist | 1115 East Getwell Loop St, Memphis, TN 38111 | 2018-01-22 |
| 1831645100 | Bobby Winbush | Residential Treatment Facility, Emotionally Disturbed Children | 1167 Parkland Rd, Memphis, TN 38111 | 2016-08-28 |
| 1356797427 | Shilo Satran | Counselor | 208 Waynoka Lane, Memphis, TN 38111 | 2016-05-09 |
| 1346580552 | Bianca Branch | Psychologist | 4166 W Bufford Ellington Dr, Memphis, TN 38111 | 2013-02-25 |
| 1043563935 | Midsouth Vision Center | Optometrist | 3314 Poplar Ave Ste#1, Memphis, TN 38111 | 2012-10-17 |
| 1235407750 | Demetria Nicole Rogers | Pharmacist | 3515 Park Avenue, Memphis, TN 38111 | 2011-12-12 |
| 1326335647 | Jason Thomas Sasser | Nurse Practitioner | 3444 Plaza Ave., The Little Clinic, Memphis, TN 38111 | 2011-07-07 |
| Find all providers in zip 38111 | ||||
| Taxonomy Code | 103TA0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Adult Development & Aging |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790785723 | Douglas J Hart | Psychologist | 3950 Central Ave, Memphis, TN 38111-7602 | 2005-08-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407328214 | Meaningful Living, LLC | Psychologist | 388 Albright Ln, Gallatin, TN 37066-8740 | 2018-12-19 |
| 1912478108 | Jason Holland | Psychologist | 106 Public Sq Ste 105, Gallatin, TN 37066 | 2018-12-16 |
| 1922329242 | Ronald Thomas Cartmell | Psychologist | 103 Trousdale Ct, Hendersonville, TN 37075-3724 | 2010-06-22 |
| 1811190952 | William Forrest Rymer | Psychologist | 85 Meadow Wood, Greeneville, TN 37745-7022 | 2007-06-07 |
| 1396745329 | Tonia L Long | Psychologist | 1100 Halle Park Circle, Ste 101, Collierville, TN 38017 | 2005-08-01 |
| 1396217816 | Lifespark Pllc | Psychologist | 106 Public Sq Ste 105, Gallatin, TN 37066 | 2018-12-21 |
| 1225450802 | Linda Smith | Psychologist | 100 N Bigby Dr, Columbia, TN 38401-4704 | 2014-01-15 |
| 1417154410 | Peggy Joyce Cantrell | Psychologist | 807 University Pkwy, Etsu Campus, Johnson City, TN 37614-6500 | 2007-07-02 |
| 1861611972 | Norma Calway-fagen | Psychologist | 2200 21st Ave S, Ste. 227, Nashville, TN 37212-4942 | 2007-04-25 |
| 1881757433 | Odacir H Oliveira | Psychologist | 2347 Jones Bend Rd, Louisville, TN 37777-5213 | 2006-12-18 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.