Individual
JAMES W JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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