Individual
MR. KEVIN LEE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2430 VILLAGE PROFESSIONAL DR, OPELIKA, AL 36801-2378
(334) 821-6300
(334) 821-1849
Mailing address
2430 VILLAGE PROFESSIONAL DR, OPELIKA, AL 36801-2378
(334) 821-6300
(334) 821-1849
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
6757
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000011573
—
AL
Enumeration date
11/04/2005
Last updated
01/26/2017
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