# JACKSON MEDICAL ASSOCIATES, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467675769
- **Authorized official:** MRS. JILL CHAMBERS (OFFICE MANAGER)
- **Authorized official phone:** (304) 372-3506

## Contact information

- **Practice address:** 122 PINNELL STREET, RIPLEY, WV 25271
- **Practice address phone:** (304) 372-3506
- **Practice address fax:** (304) 372-3523
- **Mailing address:** PO BOX 171, RIPLEY, WV 25271-0171
- **Mailing address phone:** (304) 372-3506
- **Mailing address fax:** (304) 372-3523

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 1524 | WV | Yes |

## Other

- **Enumeration date:** 04/11/2007
- **Last updated:** 11/01/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 001722717 | BLUE CROSS BLUE SHIELD | WV |
| 05 | — | 0203269000 | — | WV |