Individual
LILLIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4704 CAHABA RIVER RD # 101D, BIRMINGHAM, AL 35243-2344
(205) 739-2266
(205) 739-2335
Mailing address
PO BOX 2391, BIRMINGHAM, AL 35201-2391
(205) 868-2000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.1146
AL
Other
Enumeration date
07/15/2016
Last updated
12/31/2018
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