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Organization
NORTHCREST FAMILY MEDICINE LLC
Active
Organization
NORTHCREST FAMILY MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN RICHARD JACKSON M.D. (MD / OWNER)
(770) 655-1408
Entity
Organization
Contact information
Practice address
7768 CUMMING HWY, SUITE 300, CANTON, GA 30114-9314
(770) 720-2113
(770) 704-7365
Mailing address
7768 CUMMING HWY. STE 300, CANTON, GA 30114
(770) 720-2113
(770) 704-7365
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
056102
GA
Other
Enumeration date
03/14/2007
Last updated
03/22/2013
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