Individual
COLETTE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1000 19TH ST S, BIRMINGHAM, AL 35205-4804
(205) 930-0700
(205) 930-9127
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
52176
SC
207WX0110X
Pediatric Ophthalmology and Strabismus Specialist Physician
Primary
37977
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/17/2014
Last updated
05/22/2019
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