Healthcare Provider Details

I. General information

NPI: 1770105967
Provider Name (Legal Business Name): AMBER JACKSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 MORPHY AVE
FAIRHOPE AL
36532-1899
US

IV. Provider business mailing address

750 MORPHY AVE
FAIRHOPE AL
36532-1899
US

V. Phone/Fax

Practice location:
  • Phone: 251-928-2375
  • Fax:
Mailing address:
  • Phone: 251-928-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDO.3199
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: