# JACKSONS POINT OF LIGHT FAMILY MEDICINE INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** JPL Family Medicine, Inc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578758553
- **Authorized official:** MR. DERRIC N JACKSON (ADMINISTRATON/COO)
- **Authorized official phone:** (334) 291-5255

## Contact information

- **Practice address:** 1810 STADIUM DR, SUITE 210, PHENIX CITY, AL 36867-3177
- **Practice address phone:** (334) 291-5255
- **Practice address fax:** (877) 395-0710
- **Mailing address:** PO BOX 1045, PHENIX CITY, AL 36868-1045
- **Mailing address phone:** (334) 291-5255
- **Mailing address fax:** (877) 395-0710

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/12/2007
- **Last updated:** 03/07/2023