NPI 1043655681
Charles D Jackson
Practice location
- Address
- 4856 W.12th Suite 1, Cleveland, OH 44109-3424
- Phone
- (440) 749-3019
- Mailing address
- 4856 W 12th St, Cleveland, OH 44109-5611
Registered specialties
Driver
Primary
Registry record
- NPI
- 1043655681
- Entity type
- Individual
- Sex (as registered)
- Male
- NPI issued
- 9 May 2013
- Record last updated
- 22 Nov 2013
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.