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NPI Code Detail

MEDICARE: LATOYA JACKSON

MEDICARE: LATOYA JACKSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1376J00000XHomemaker202600003153AL

General Provider Information

NPI Number : 1659226058
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATOYA JACKSON
Provider Business Mailing Address
First Line : 5510 WARES FERRY RD STE F
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-2129
Country : US
Telephone Number : 334-676-2422
Fax Number :
Provider Business Practice Location Address
First Line : 5510 WARES FERRY RD STE F
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-2129
Country : US
Telephone Number : 334-676-2422
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2026
Last Update Date : 03/02/2026

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Directions to “ LATOYA JACKSON ” Practice Location

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