Organization
MICHAEL S. JACKSON, MD, PC
Active
Other names
Your Personal Physician
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL S JACKSON MD (PRESIDENT)
(706) 266-9090
Entity
Organization
Contact information
Practice address
701 E 2ND AVE SW, SUITE C, ROME, GA 30161-6148
(706) 266-9090
(706) 204-8797
Mailing address
PO BOX 40, SILVER CREEK, GA 30173-0040
(706) 266-9090
(706) 204-8797
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
055376
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08BBRKT
MEDICARE PTAN
GA
01
—
1306830062
MEDICARE INDIVIDUAL NPI
—
Enumeration date
03/10/2010
Last updated
01/20/2011
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