Basic Information
| Provider Information | |||||||||
| NPI: | 1629503271 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACOBS | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 619 19TH ST S # 338 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352496830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059343166 | ||||||||
| FaxNumber: | 2059754413 | ||||||||
| Practice Location | |||||||||
| Address1: | 619 19TH ST S # JTN338 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059343166 | ||||||||
| FaxNumber: | 2059754413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2017 | ||||||||
| LastUpdateDate: | 06/27/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.