Organization
BILLIE L. JACKSON, M.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BILLIE L JACKSON M.D. (OWNER)
(478) 477-5575
Entity
Organization
Contact information
Practice address
440 CHARTER BLVD, SUITE 2201, MACON, GA 31210-0724
(478) 477-5575
(478) 477-0707
Mailing address
440 CHARTER BLVD, SUITE 2201, MACON, GA 31210-0724
(478) 477-5575
(478) 477-0707
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
030791
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000373513E
—
GA
Enumeration date
12/15/2011
Last updated
12/15/2011
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