Funches-Jackson, Kimberly Ann
Funches-Jackson, Kimberly Ann is an individual health care provider with primary practice located at 1810 Stadium Dr Suite 210, Phenix City AL 36867-3177. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Funches-Jackson, Kimberly Ann can be contacted via phone (334) 297-1085.Contact Information
Primary practice address
1810 Stadium Dr Suite 210
Phenix City AL 36867-3177
Phone: (334) 297-1085
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 056705 | Georgia |
Profile Details
| NPI number | 1497705123 |
|---|---|
| LBN Legal business name | Funches-Jackson, Kimberly Ann |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 11th, 2006 |
| Last updated | Feb 27th, 2017 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1497705123 | NPPES |
| Georgia | Other | 056705 | GA LICENSE |
| Georgia | Other | 26806 | GA LICENSE |
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