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General NPI Number Information
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NPI Number | 1114398427
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Entity Type | Organization
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Legal Business Name | DR JOE A JACKSON, MD PLLC
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Dates
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Enumeration Date | 10/13/2015
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Last Update Date | 10/13/2015
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Provider Practice Location Address
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Address Line | 224 E GARDEN ST SUITE 5B BOX J16
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City | PENSACOLA
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State | FL
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Zip | 32502-6068
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Country | US
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Telephone | 850-469-1330
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Fax | 850-469-1554
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Provider Business Mailing Address
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Address Line | 224 E GARDEN ST SUITE 5B BOX J16
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City | PENSACOLA
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State | FL
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Zip | 32502-6068
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Country | US
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Telephone | 850-469-1330
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Fax | 850-469-1554
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOE A JACKSON
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Credential | MD
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Telephone | 850-469-1330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 85613
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License Number State | FL
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