Organization
DECATUR INTERNAL MEDICINE CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIRK LEE JACKSON M.D. (PRESIDENT)
(256) 350-6363
Entity
Organization
Contact information
Practice address
2506 DANVILLE RD SW, SUITE 101, DECATUR, AL 35603-4232
(256) 350-6363
(256) 350-6855
Mailing address
PO BOX 870, CULLMAN, AL 35056-0870
(256) 775-0432
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DG3025
RAILROAD MEDICARE
AL
Enumeration date
06/25/2006
Last updated
12/20/2007
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