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General NPI Number Information
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NPI Number | 1093656829
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Entity Type | Organization
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Legal Business Name | JACKSON FORENSIC PSYCHIATRY LLC
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Dates
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Enumeration Date | 04/04/2026
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Last Update Date | 04/04/2026
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Provider Practice Location Address
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Address Line | 2100 CENTRAL AVE STE D1
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City | AUGUSTA
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State | GA
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Zip | 30904-6709
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Country | US
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Telephone | 912-216-2278
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Fax |
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Provider Business Mailing Address
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Address Line | 2801 WASHINGTON RD STE 107 #275
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City | AUGUSTA
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State | GA
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Zip | 30909
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Country | US
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Telephone | 912-216-2278
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST/ OWNER
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Name | ANNA JACKSON
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Credential | MD
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Telephone | 912-216-2278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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License Number |
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License Number State |
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