Individual ProviderHarris JacksonFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address3650 Joseph Siewick Dr Ste 400, Fairfax, VA 22033-1715(703) 391-2020PECOS EnrollmentBased on the most recent information from CMS, provider Harris Jackson is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1255175303Provider TypeIndividualFull NameJackson, HarrisGenderMaleSole ProprietorNoEnumeration Date6/24/2024Last Updated6/24/2024Contact InformationPractice LocationPractice Address3650 Joseph Siewick Dr Ste 400, Fairfax, VA 22033-1715Phone(703) 391-2020Fax(703) 264-9861Mailing LocationMailing Address3650 Joseph Siewick Dr Ste 400, Fairfax, VA 22033-1715Phone(703) 391-2020Fax(703) 264-9861Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense0116039772Virginia