Individual
BILLY JACOBS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
404 N MAIN ST, ENTERPRISE, AL 36330-2563
(334) 308-9797
Mailing address
404 N MAIN ST, ENTERPRISE, AL 36330-2563
(334) 308-9797
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA.1898
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/27/2019
Last updated
03/09/2022
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