Provider Demographics
NPI:1437454824
Name:ALSTON, JACKIE JOE JR (CSA)
Entity Type:Individual
Prefix:MR
First Name:JACKIE
Middle Name:JOE
Last Name:ALSTON
Suffix:JR
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:JOEY
Other - Middle Name:
Other - Last Name:ALSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSA
Mailing Address - Street 1:PO BOX 936535
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6535
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 GLEN ECHO RD STE 111
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2857
Practice Address - Country:US
Practice Address - Phone:615-657-4805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN64246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant