Provider Demographics
NPI:1225716525
Name:JACKSON, ERICA J
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:J
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E BROAD ST STE 8A
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-2024
Mailing Address - Country:US
Mailing Address - Phone:334-232-9063
Mailing Address - Fax:334-232-4724
Practice Address - Street 1:110 E BROAD ST STE 8A
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-2024
Practice Address - Country:US
Practice Address - Phone:334-232-9063
Practice Address - Fax:334-232-4724
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA