Individual
ELICEIA DIONNE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12701 PADGETT SWITCH RD, IRVINGTON, AL 36544-4011
(251) 824-2174
(251) 824-2286
Mailing address
12701 PADGETT SWITCH RD, IRVINGTON, AL 36544-4011
(251) 824-2174
(251) 824-2286
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
21663
MS
207Q00000X
Family Medicine Physician
Primary
46088
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09180751
—
MS
Enumeration date
07/01/2008
Last updated
03/31/2023
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