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General NPI Number Information
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NPI Number | 1912645623
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Entity Type | Organization
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Legal Business Name | JACKSON CENTER
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Dates
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Enumeration Date | 05/23/2022
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 198 NARROWS DR STE 105
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City | BIRMINGHAM
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State | AL
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Zip | 35242-8663
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Country | US
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Telephone | 901-647-8291
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Fax |
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Provider Business Mailing Address
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Address Line | 470 NORTH ST
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City | HERNANDO
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State | MS
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Zip | 38632-1732
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Country | US
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Telephone | 901-647-8291
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | BEN HARRELL
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Credential |
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Telephone | 901-647-8291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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