Individual
DR. JOSEPH L JACKSON SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
305 JONES AVE, WAYNESBORO, GA 30830-1510
(706) 554-5147
(706) 554-6111
Mailing address
305 JONES AVE, WAYNESBORO, GA 30830-1510
(706) 554-5147
(706) 554-6111
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
013980
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000172213A
—
GA
05
—
000172213C
—
GA
01
—
080028937
PALMETTO GBA RAILROAD
GA
01
—
080083685
PALMETTO GBA RAILROAD
GA
Enumeration date
06/09/2006
Last updated
08/11/2015
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