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Contact Information

JACKSON FAMILY DENTISTRY PC
2009 TEBEAU STREET
WAYCROSS, GA31501
 Phone: 912-283-1340
 Fax: 912-283-0334
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
Indicates primary specialty

NPI Profile & details for JACKSON FAMILY DENTISTRY PC · (Female)

NPI Number 1124157847
Status Active
Credentials
Entity Individual
Enumeration date 03/06/2007
Last updated 02/12/2008 - About 18 years ago
Sole proprietor 1 Not specified
Identifiers
  • GA License # 9840
  • GA License # 9939
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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