# JACKSON HOSPITAL AND CLINIC, INC

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

## Provider details

- **NPI number:** 1861827297
- **Authorized official:** KELIN PENNEY (ADMINISTRATOR)
- **Authorized official phone:** (334) 240-2335

## Contact information

- **Practice address:** 11123 CHANTILLY PKWY CT, STE M, PIKE ROAD, AL 36064-2880
- **Practice address phone:** (334) 293-8888
- **Mailing address:** 1722 PINE ST, STE 503, MONTGOMERY, AL 36106-1103
- **Mailing address phone:** (334) 293-8888

## Taxonomy

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

## Other

- **Enumeration date:** 09/04/2013
- **Last updated:** 05/21/2019