Individual
DEEANNE S JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1616 6TH AVE S, BIRMINGHAM, AL 35233-1788
(205) 939-9585
(205) 975-6503
Mailing address
703 VOLKER HALL, BIRMINGHAM, AL 35294-0001
(205) 934-3795
(205) 975-2499
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
15540
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000025149
—
AL
05
—
000028944
—
AL
05
—
009999685
—
AL
01
—
510-25149
BC BS
AL
01
—
E89479
VIVA
—
Enumeration date
07/20/2006
Last updated
01/14/2011
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