Organization
JACKSONS POINT OF LIGHT FAMILY MEDICINE INC.
Active
Other names
JPL Family Medicine, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DERRIC N JACKSON (ADMINISTRATON/COO)
(334) 291-5255
Entity
Organization
Contact information
Practice address
1810 STADIUM DR, SUITE 210, PHENIX CITY, AL 36867-3177
(334) 291-5255
(877) 395-0710
Mailing address
PO BOX 1045, PHENIX CITY, AL 36868-1045
(334) 291-5255
(877) 395-0710
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
053082406B
—
GA
01
—
056705
GA LICENSE
GA
05
—
101067
—
AL
01
—
MD 26806
AL LICENSE
AL
Enumeration date
09/12/2007
Last updated
03/07/2023
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