Healthcare Provider Details

I. General information

NPI: 1235361908
Provider Name (Legal Business Name): JACKSON P. MORGAN, III, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 WATERS AVE SUITE 504
SAVANNAH GA
31404-6220
US

IV. Provider business mailing address

4700 WATERS AVE SUITE 504
SAVANNAH GA
31404-6220
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-9330
  • Fax: 912-355-9355
Mailing address:
  • Phone: 912-355-9330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number011606
License Number StateGA

VIII. Authorized Official

Name: DR. JACKSON P MORGAN III
Title or Position: OWNER
Credential: DDS
Phone: 912-355-9330