Healthcare Provider Details

I. General information

NPI: 1407916471
Provider Name (Legal Business Name): THOMASVILLE OBSTETRICS AND GYNECOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S HANSELL ST
THOMASVILLE GA
31792-5560
US

IV. Provider business mailing address

805 S HANSELL ST
THOMASVILLE GA
31792-5560
US

V. Phone/Fax

Practice location:
  • Phone: 229-225-1357
  • Fax: 229-225-9935
Mailing address:
  • Phone: 229-225-1357
  • Fax: 229-225-9935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN159084
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number030793
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number046464
License Number StateGA

VIII. Authorized Official

Name: DR. OSCAR DUNWODY JACKSON JR.
Title or Position: OWNER
Credential: M.D.
Phone: 229-225-1357