Healthcare Provider Details

I. General information

NPI: 1699138479
Provider Name (Legal Business Name): JASON CODY PICKETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 VANN RD STE 100
BIRMINGHAM AL
35235-3221
US

IV. Provider business mailing address

362 S THOMAS ST
TUPELO MS
38801-5333
US

V. Phone/Fax

Practice location:
  • Phone: 205-655-0585
  • Fax: 205-655-0586
Mailing address:
  • Phone: 662-223-3737
  • Fax: 601-429-9294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25116
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number51927
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number51927
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: