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General NPI Number Information
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NPI Number | 1326750084
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Entity Type | Organization
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Legal Business Name | JACKSON HOSPITAL AND CLINIC, INC
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Dates
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Enumeration Date | 12/14/2022
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Last Update Date | 03/09/2026
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Provider Practice Location Address
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Address Line | 2024 CHESTNUT ST
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City | MONTGOMERY
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State | AL
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Zip | 36106-1111
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Country | US
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Telephone | 334-293-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1722 PINE ST STE 804
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City | MONTGOMERY
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State | AL
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Zip | 36106-1108
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Country | US
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Telephone | 334-293-8736
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KELIN PENNEY
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Credential |
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Telephone | 334-240-2335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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