Individual
DR. KIRK LEE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
(855) 230-8290
(256) 775-6305
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD18273
AL
207R00000X
Internal Medicine Physician
Primary
18273
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110160764
RAILROAD MEDICARE
AL
05
—
1316977945
—
AL
01
—
51077099
BLUE CROSS & BLUE SHIELD
AL
05
—
77099
—
AL
Enumeration date
07/03/2006
Last updated
10/05/2011
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