Organization
JOHN M. JACKSON, JR., D.M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN MORGAN JACKSON JR. D.M.D. (PRESIDENT)
(706) 845-0544
Entity
Organization
Contact information
Practice address
304 S LEWIS ST, LAGRANGE, GA 30240-3144
(706) 845-0544
Mailing address
304 S LEWIS ST, LAGRANGE, GA 30240-3144
(706) 845-0544
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN010331
GA
Other
Enumeration date
12/31/2012
Last updated
12/31/2012
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