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Contact Information

SAMUEL H JACKSON JR, CRNP-FNP-C
6074 LAKESIDE DR
PINSON, AL35126-2300
 Phone: 205-243-4751
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Occupational Health

111NX0100X 35 Chiropractic
Indicates primary specialty

NPI Profile & details for SAMUEL H JACKSON JR · (Male)

NPI # 1497445811
Status Active
Credentials CRNP-FNP-C
Entity Individual
Enumeration date 05/09/2023
Last updated 05/09/2023 - About 3 years ago
Sole proprietor 1 No
Identifiers
  • AL License # 111NX0100X
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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