Individual
DR. LORI ANN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
22216 SOUTH AVE, FLORALA, AL 36442-3144
(334) 767-9052
Mailing address
22216 SOUTH AVE, FLORALA, AL 36442-3144
(334) 767-9052
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01043364
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200056900
—
IN
05
—
64880404
—
KY
Enumeration date
01/26/2009
Last updated
01/26/2009
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