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General NPI Number Information
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NPI Number | 1023974730
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Entity Type | Organization
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Legal Business Name | JACKSON MOBILITY SOLUTIONS, LLC
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Dates
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Enumeration Date | 12/27/2025
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Last Update Date | 12/27/2025
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Provider Practice Location Address
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Address Line | 4118 ELDERS DR
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City | AUGUSTA
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State | GA
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Zip | 30909-9133
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Country | US
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Telephone | 706-360-9865
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Fax | 706-360-9865
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Provider Business Mailing Address
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Address Line | 4118 ELDERS DR
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City | AUGUSTA
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State | GA
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Zip | 30909-9133
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Country | US
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Telephone | 706-360-9865
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Fax | 706-360-9865
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Authorized Official
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Title or Position | OWNER
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Name | MYRICK LAROMAN JACKSON
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Credential |
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Telephone | 706-360-9865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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