Healthcare Provider Details

I. General information

NPI: 1902749849
Provider Name (Legal Business Name): JOMARI JACKSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5106 OAK ST
EASTMAN GA
31023-6027
US

IV. Provider business mailing address

5106 OAK ST
EASTMAN GA
31023-6027
US

V. Phone/Fax

Practice location:
  • Phone: 478-242-6965
  • Fax:
Mailing address:
  • Phone: 478-242-6965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN124408
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: