Individual
LEWIS W. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2959 SHARPSBURG MCCOLLUM RD, NEWNAN, GA 30265-2297
(770) 502-2000
(770) 502-2009
Mailing address
2959 SHARPSBURG MCCOLLUM RD, NEWNAN, GA 30265-2297
(770) 502-2000
(770) 502-2009
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
042294
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000717131E
—
GA
Enumeration date
12/01/2005
Last updated
03/15/2018
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