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General NPI Number Information
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NPI Number | 1467675769
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Entity Type | Organization
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Legal Business Name | JACKSON MEDICAL ASSOCIATES, PLLC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 122 PINNELL STREET
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City | RIPLEY
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State | WV
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Zip | 25271
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Country | US
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Telephone | 304-372-3506
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Fax | 304-372-3523
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Provider Business Mailing Address
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Address Line | PO BOX 171
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City | RIPLEY
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State | WV
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Zip | 25271-0171
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Country | US
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Telephone | 304-372-3506
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Fax | 304-372-3523
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JILL CHAMBERS
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Credential |
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Telephone | 304-372-3506
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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 | 1524
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License Number State | WV
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