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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

NPI # 1124157847
LBN Legal business name JACKSON FAMILY DENTISTRY PC
Authorized official ANDREW JACKSON - (OWNER PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 03/06/2007
Last updated 02/12/2008 - About 18 years ago
Identifiers
GA License # 9840
GA License # 9939
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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