Provider Demographics
NPI:1679654339
Name:NORTH JACKSON PRIMARY CARE
Entity Type:Organization
Organization Name:NORTH JACKSON PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:256-437-2223
Mailing Address - Street 1:42319 US HIGHWAY 72
Mailing Address - Street 2:PO BOX 406
Mailing Address - City:STEVENSON
Mailing Address - State:AL
Mailing Address - Zip Code:35772-5418
Mailing Address - Country:US
Mailing Address - Phone:256-437-2223
Mailing Address - Fax:256-437-2225
Practice Address - Street 1:42319 US HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:AL
Practice Address - Zip Code:35772-5418
Practice Address - Country:US
Practice Address - Phone:256-437-2223
Practice Address - Fax:256-437-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00026933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI41564Medicare UPIN