| NPI | 1164803367 |
|---|---|
| Doing Business As | JACKSON UROLOGY EAST |
| Entity Type | Organization |
| Authorized Contact | KELIN PENNEY Administrator 334-240-2337 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 208800000X Urology |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2019-05-21 |