Healthcare Provider Details

I. General information

NPI: 1093656829
Provider Name (Legal Business Name): JACKSON FORENSIC PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2100 CENTRAL AVE STE D1
AUGUSTA GA
30904-6709
US

IV. Provider business mailing address

2801 WASHINGTON RD STE 107 #275
AUGUSTA GA
30909
US

V. Phone/Fax

Practice location:
  • Phone: 912-216-2278
  • Fax:
Mailing address:
  • Phone: 912-216-2278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNA JACKSON
Title or Position: PSYCHIATRIST/ OWNER
Credential: MD
Phone: 912-216-2278