Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 0101262212 | VA |
NPI | 1003259904 |
---|---|
Provider Name | Dr. Brittany Ann Jackson |
First Address | Fulton, MD 20759-2694 |
Second Address | Alexandria, VA 22310-3251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2013 |
Last Update Date | 13/05/2021 |