Healthcare Provider Details

I. General information

NPI: 1841752573
Provider Name (Legal Business Name): ISAAC JACKS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 HARPER ST
AUGUSTA GA
30912-0012
US

IV. Provider business mailing address

1446 HARPER ST
AUGUSTA GA
30912-0012
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2457
  • Fax:
Mailing address:
  • Phone: 706-721-2457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number90404
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number91646
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: