Jackson, Jerry W
Jackson, Jerry W is an individual health care provider with primary practice located at 817 Princeton Ave Sw Suite 210, Birmingham AL 35211. He recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as his primary health care specialty. Jackson, Jerry W can be contacted via phone (205) 226-5911.Contact Information
Primary practice address
817 Princeton Ave Sw Suite 210
Birmingham AL 35211
Phone: (205) 226-5911
Fax: (205) 226-5939
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Nephrology | 207RN0300X | 6279 | Alabama |
Profile Details
| NPI number | 1467400051 |
|---|---|
| LBN Legal business name | Jackson, Jerry W |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 5th, 2006 |
| Last updated | Jan 12th, 2011 - about 13 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 | 1467400051 | NPPES |
| Alabama | MEDICAID | 000003165 |
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