Healthcare Provider Details

I. General information

NPI: 1700572666
Provider Name (Legal Business Name): JACKSON STRONG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 17TH ST S
BIRMINGHAM AL
35205-5553
US

IV. Provider business mailing address

1307 17TH ST S
BIRMINGHAM AL
35205-5553
US

V. Phone/Fax

Practice location:
  • Phone: 904-521-8004
  • Fax:
Mailing address:
  • Phone: 904-521-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number73591
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: