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NPI Code Detail

MEDICARE: JOSEPH M JACKSON III MD

MEDICARE: JOSEPH M JACKSON III MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician039374GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811980352
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH M JACKSON III MD
Provider Business Mailing Address
First Line : 2701 MEREDYTH DR
Second Line :
City : ALBANY
State : GA
Zip : 31707-2267
Country : US
Telephone Number : 229-883-7010
Fax Number : 229-435-4022
Provider Business Practice Location Address
First Line : 2701 MEREDYTH DR
Second Line :
City : ALBANY
State : GA
Zip : 31707-2267
Country : US
Telephone Number : 229-883-7010
Fax Number : 229-435-4022
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2005
Last Update Date : 12/20/2022

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