Individual
CALVIN R JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2123 WRIGHTSBORO RD, AUGUSTA, GA 30904-4777
(706) 736-5244
(706) 736-5246
Mailing address
2123 WRIGHTSBORO RD, AUGUSTA, GA 30904-4777
(706) 736-5244
(706) 736-5246
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
031265
GA
207R00000X
Internal Medicine Physician
16449
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000623796B
—
GA
05
—
164495
—
SC
Enumeration date
08/25/2006
Last updated
03/28/2008
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