Individual
JAMES W JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
450 GEORGIA AVE, STE B, STATESBORO, GA 30458
(912) 489-4123
(912) 764-4977
Mailing address
450 GEORGIA AVE, STE B, STATESBORO, GA 30458
(912) 489-4123
(912) 764-4977
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
034372
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000569687D
—
GA
05
—
000569687E
—
GA
05
—
000569687F
—
GA
05
—
000569687G
—
GA
05
—
000569687H
—
GA
05
—
000569687Q
—
GA
05
—
000569687R
—
GA
05
—
000569687S
—
GA
05
—
000569687T
—
GA
05
—
000569687V
—
GA
05
—
000569687X
—
GA
01
—
10063368
AMERIGROUP
GA
01
—
366237
WELLCARE
GA
01
—
390006768
RAILROAD MEDICARE
GA
Enumeration date
10/03/2006
Last updated
10/09/2013
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