NPIMap

Organization Active NPI

John M. Jackson, Jr., D.M.D., P.C.

  • General Practice Dentistry
  • Lagrange, GA
National Provider Identifier
1033455647
Registry record updated Dec 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN010331 Issued in GA
Legal business name
JOHN M. JACKSON, JR., D.M.D., P.C.
Practice address
304 S Lewis St
Lagrange, GA 30240-3144
Phone
(706) 845-0544
NPI assigned
Dec 31, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. John Morgan Jackson Jr., D.M.D.NPI 1992225270
Title
President
Phone
(706) 845-0544

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN010331 GA Primary

Addresses

Primary practice location

304 S Lewis St
Lagrange, GA 30240-3144

Mailing address

304 S Lewis St
Lagrange, GA 30240-3144
Phone (706) 845-0544

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1356912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356912000000",
    "number": "1033455647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 S LEWIS ST",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302403144",
            "telephone_number": "706-845-0544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 S LEWIS ST",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302403144",
            "telephone_number": "706-845-0544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN M. JACKSON, JR., D.M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-31",
        "last_updated": "2012-12-31",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MORGAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-845-0544",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN010331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lagrange, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.