Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Alfred Vaughn Derise Jackson Jr., MD

Individual provider Emergency Medicine Physician · NPI 1609189695

Alfred Vaughn Derise Jackson Jr., MD is a Family Practice in Knoxville, Tennessee. Qualified in 2010, 16 years ago. Practices with Emergency Coverage LLC, a 771-clinician group and accepts Medicare assignment. Licensed in Tennessee.

Years since qualifying
16
Licensed in
TN
In the registry since
2010
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

930 Adell Ree Park Ln
Knoxville, TN 37909-2543
Phone: (865) 769-2600
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 50821 (TN)
Emergency Medicine Physician Taxonomy 207P00000X · Licence 50821 (TN)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1609189695
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 19, 2010
Last updated in NPPESMarch 23, 2023
Certification dateMarch 23, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2010 (16 years in practice)
Group practice Emergency Coverage Llc — 771 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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