Organization
SOUTHEASTERN OB/GYN CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL J JACKSON M.D. (OWNER)
(912) 355-1111
Entity
Organization
Contact information
Practice address
5311 PAULSEN ST, SAVANNAH, GA 31405-4800
(912) 355-1111
(912) 352-7136
Mailing address
5311 PAULSEN ST, SAVANNAH, GA 31405-4800
(912) 355-1111
(912) 352-7136
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
038019
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00729473A
—
GA
01
—
038019
LICENSE
GA
Enumeration date
06/02/2011
Last updated
03/07/2023
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