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General NPI Number Information
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NPI Number | 1790601995
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Entity Type | Organization
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Legal Business Name | S. JACKSON PSYCHIATRY
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Dates
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Enumeration Date | 06/24/2026
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Last Update Date | 06/24/2026
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Provider Practice Location Address
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Address Line | 145 1ST ST
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City | MACON
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State | GA
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Zip | 31201-2627
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Country | US
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Telephone | 478-216-3126
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Fax |
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Provider Business Mailing Address
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Address Line | 6711 CHRISWOOD DR
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City | MACON
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State | GA
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Zip | 31216-6721
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Country | US
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Telephone | 478-216-3126
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHACARYA JACKSON
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Credential | APRN
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Telephone | 478-216-3126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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