Individual
DR. ANDREW LEE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
600 MCCRANIE AVENUE, WILLACOOCHIE, GA 31650
(912) 534-5164
(912) 534-5263
Mailing address
PO BOX 206, WILLACOOCHEE, GA 31650
(912) 534-5164
(912) 534-5263
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9939
GA
Other
Enumeration date
03/06/2007
Last updated
07/08/2007
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