Healthcare Provider Details

I. General information

NPI: 1679497937
Provider Name (Legal Business Name): CARMESIA JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

873 DENNISON AVE SW STE 102
BIRMINGHAM AL
35211-3867
US

IV. Provider business mailing address

405 BELCHER ST
CENTREVILLE AL
35042-2946
US

V. Phone/Fax

Practice location:
  • Phone: 205-774-3309
  • Fax: 205-316-7675
Mailing address:
  • Phone: 205-926-2992
  • Fax: 205-316-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: