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Organization
JACKSON HOSPITAL AND CLINIC, INC
Active
Organization
JACKSON HOSPITAL AND CLINIC, INC
Active
Other names
Jackson Family Medicine Pike Road
Organization subpart
No
Provider details
NPI number
Authorized official
KELIN PENNEY (ADMINISTRATOR)
(334) 240-2335
Entity
Organization
Contact information
Practice address
11123 CHANTILLY PKWY CT, STE M, PIKE ROAD, AL 36064-2880
(334) 293-8888
Mailing address
1722 PINE ST, STE 503, MONTGOMERY, AL 36106-1103
(334) 293-8888
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
09/04/2013
Last updated
05/21/2019
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