Individual
DR. JOHN M JACKSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
304 S LEWIS ST, LAGRANGE, GA 30240-3144
(706) 845-0544
(706) 812-8791
Mailing address
304 S LEWIS ST, LAGRANGE, GA 30240-3144
(706) 845-0544
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN010331
GA
Other
Enumeration date
08/16/2006
Last updated
07/08/2007
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