Provider Demographics
NPI:1568478261
Name:ACKERSON, JOSEPH DANIEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DANIEL
Last Name:ACKERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:400 VESTAVIA PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-3750
Mailing Address - Country:US
Mailing Address - Phone:205-823-2373
Mailing Address - Fax:205-823-2378
Practice Address - Street 1:400 VESTAVIA PKWY STE 130
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-3750
Practice Address - Country:US
Practice Address - Phone:205-823-2373
Practice Address - Fax:205-823-2378
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL763103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR63325Medicare UPIN