Healthcare Provider Details

I. General information

NPI: 1407859127
Provider Name (Legal Business Name): JERNIGAN HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 DECATUR HWY
FULTONDALE AL
35068-1815
US

IV. Provider business mailing address

PO BOX 879
FULTONDALE AL
35068-0879
US

V. Phone/Fax

Practice location:
  • Phone: 205-631-1520
  • Fax: 205-631-1522
Mailing address:
  • Phone: 205-631-1520
  • Fax: 205-631-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number182
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number23573
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number23756
License Number StateAL

VIII. Authorized Official

Name: MR. JAMES E JERNIGAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 205-631-1520