Individual
MELVIN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
777 HEMLOCK ST, HB 64, MACON, GA 31201-2102
(478) 633-2097
(478) 633-7836
Mailing address
120 HUDSON WAY, MACON, GA 31216-6188
(478) 788-0404
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
039134
GA
Other
Enumeration date
08/29/2006
Last updated
07/08/2007
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