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LASALLE JACKSON

>> Driver >> Other Service Providers

Registrant NPI Number: 1508331711

Individual Registrant:
 LASALLE  JACKSON 
Gender: M
Not Sole Proprietor

Location and contact information for practice:
606 WALNUT ST  PORT GIBSON, MS 39150-2140 US
Tel: 601-529-0527  Fax: --

Contact information for business:
606 WALNUT ST  PORT GIBSON, MS 39150-2140 US
Tel: 601-529-0527  Fax: --

Registration Information:
NPI: 1508331711
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y172A00000XOther Service Providers
Driver
MS

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




HEALTH CARE JOBS MS - Page 1



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