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General NPI Number Information
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NPI Number | 1194855072
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Entity Type | Individual
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Provider Name | SHEILA JACKSON
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5067 BUSINESS PARK DR
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City | MONTGOMERY
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State | AL
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Zip | 36116
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Country | US
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Telephone | 334-612-2100
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Fax | 334-612-2148
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Provider Business Mailing Address
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Address Line | 4220 TROY HWY
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City | MONTGOMERY
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State | AL
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Zip | 36116-2618
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Country | US
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Telephone | 334-612-2100
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Fax | 331-612-2148
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 749
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License Number State | AL
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