Organization
LAWRENCE RICHARD JACKSON JR. MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE RICHARD JACKSON JR. MD (OWNER)
(931) 296-3555
Entity
Organization
Contact information
Practice address
104 HILLWOOD DR, WAVERLY, TN 37185-2116
(931) 296-3555
(931) 296-9085
Mailing address
PO BOX 270, WAVERLY, TN 37185-0270
(931) 296-3555
(931) 296-9085
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3724150
—
TN
Enumeration date
06/19/2007
Last updated
11/21/2025
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