| Organization Name: | JACOBS CLINIC, INC. |
| NPI Number: | 1033508791 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT SCOTT JACOBS (NURSE PRACTITIONER/OWNER) |
| Mailing Address: | 403 Lister St A Waycross |
| State: | GA US |
| Postal Code: | 315015225 |
| Phone Number: | 9128168956 |
| Fax Number: | |
| NPI Enumeration Date: | 01/20/2015 |
| NPI Last Update Date: | 01/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN121991NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |