Doctor Name: | MR. DAVID RAY JACKSON |
NPI Number: | 1215079983 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | NP |
License Number: | RN154383 |
Business Practice Address: | 606 W Screven St Quitman, GA - 316431922 |
Business Phone Number: | 2292638888 |
Business Fax Number: | 2292638888 |
Mailing Address: | Po Box 845, QUITMAN |
State: | GA |
Postal Code: | 316430845 |
Phone Number: | 2292638888 |
Fax Number: | 2292636528 |
NPI Enumeration Date: | 02/12/2007 |
NPI Last Update Date: | 03/30/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN154383 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |