Healthcare Provider Details

I. General information

NPI: 1376542951
Provider Name (Legal Business Name): JAMES LEE JACKSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MEDICAL HEIGHTS DR SUITE M
FRANKFORT KY
40601-4137
US

IV. Provider business mailing address

101 MEDICAL HEIGHTS DR SUITE M
FRANKFORT KY
40601-4137
US

V. Phone/Fax

Practice location:
  • Phone: 502-227-7538
  • Fax: 502-227-9248
Mailing address:
  • Phone: 502-227-7538
  • Fax: 502-227-9248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number23520
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23520
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: