Provider Demographics
NPI:1629025499
Name:MULBERRY MEDICAL ASSOCIATES, P.C
Entity Type:Organization
Organization Name:MULBERRY MEDICAL ASSOCIATES, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:JERNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-265-6153
Mailing Address - Street 1:1301 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1132
Mailing Address - Country:US
Mailing Address - Phone:334-265-6153
Mailing Address - Fax:334-265-6943
Practice Address - Street 1:1301 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1132
Practice Address - Country:US
Practice Address - Phone:334-265-6153
Practice Address - Fax:334-265-6943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty