# JACKSON HOSPITAL AND CLINIC, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jackson Family Medicine- Prattville
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720325889
- **Authorized official:** MRS. TARA C. HERRING (REVENUE CYCLE DIRECTOR)
- **Authorized official phone:** (334) 240-2337

## Contact information

- **Practice address:** 701 MCQUEEN SMITH RD S, PRATTVILLE, AL 36066-7503
- **Practice address phone:** (334) 351-2040
- **Practice address fax:** (334) 351-2047
- **Mailing address:** 1722 PINE ST, STE 503, MONTGOMERY, AL 36106-1103

## Taxonomy

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

## Other

- **Enumeration date:** 01/09/2013
- **Last updated:** 03/24/2016