Individual
BILLIE LUKE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
440 CHARTER BLVD, SUITE 2201, MACON, GA 31210-4857
(478) 477-5575
(478) 477-0707
Mailing address
440 CHARTER BLVD, SUITE 2201, MACON, GA 31210-4857
(478) 477-5575
(478) 477-0707
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
30791
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000373513E
—
GA
Enumeration date
09/06/2006
Last updated
11/03/2011
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