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NPI Code Detail

MEDICARE: DR. RICHARD JACKSON MD

MEDICARE: DR. RICHARD JACKSON MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician17867MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215994231
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD JACKSON MD
Provider Business Mailing Address
First Line : PO BOX 235019
Second Line :
City : MONTGOMERY
State : AL
Zip : 36123-5019
Country : US
Telephone Number : 334-279-1450
Fax Number : 334-279-1660
Provider Business Practice Location Address
First Line : 1400 E UNION ST
Second Line :
City : GREENVILLE
State : MS
Zip : 38703-3246
Country : US
Telephone Number : 662-378-3783
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2006
Last Update Date : 07/21/2022

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