Healthcare Provider Details

I. General information

NPI: 1023974730
Provider Name (Legal Business Name): JACKSON MOBILITY SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2025
Last Update Date: 12/27/2025
Certification Date: 12/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4118 ELDERS DR
AUGUSTA GA
30909-9133
US

IV. Provider business mailing address

4118 ELDERS DR
AUGUSTA GA
30909-9133
US

V. Phone/Fax

Practice location:
  • Phone: 706-360-9865
  • Fax: 706-360-9865
Mailing address:
  • Phone: 706-360-9865
  • Fax: 706-360-9865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MYRICK LAROMAN JACKSON
Title or Position: OWNER
Credential:
Phone: 706-360-9865