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General NPI Number Information
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NPI Number | 1861827297
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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 | 09/04/2013
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Last Update Date | 05/21/2019
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Provider Practice Location Address
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Address Line | 11123 CHANTILLY PKWY CT STE M
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City | PIKE ROAD
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State | AL
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Zip | 36064-2880
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Country | US
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Telephone | 334-293-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 1722 PINE ST STE 503
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City | MONTGOMERY
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State | AL
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Zip | 36106-1103
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Country | US
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Telephone | 334-293-8888
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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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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