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General NPI Number Information
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NPI Number | 1144389347
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Entity Type | Individual
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Provider Name | ROBERT W JACKSON DDS
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Gender | Male
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 209 MIMOSA DR
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City | THOMASVILLE
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State | GA
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Zip | 31792-6633
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Country | US
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Telephone | 229-226-1919
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Fax | 229-226-7709
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Provider Business Mailing Address
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Address Line | PO BOX 1696
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City | THOMASVILLE
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State | GA
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Zip | 31799-1696
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Country | US
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Telephone | 229-226-1919
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Fax | 229-226-7709
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN007586
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License Number State | GA
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