Individual
LESIA TYSON JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4700 WATERS AVE, SAVANNAH, GA 31404-6220
(912) 355-8188
(912) 356-6970
Mailing address
PO BOX 15759, SAVANNAH, GA 31416-2459
(912) 355-8188
(912) 356-6970
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
9600354
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078632737A
—
GA
01
—
52223821001
BCBS
GA
05
—
8984140
—
NC
05
—
N00354
—
SC
01
—
P00391009
RAILROAD MEDICARE
GA
Enumeration date
04/05/2006
Last updated
05/20/2008
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