Lawrence Richard Jackson Jr. MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LAWRENCE RICHARD JACKSON JR. MD

Practice address

104 Hillwood Dr
Waverly, TN 37185-2116

Phone

(931) 296-3555

Fax

(931) 296-9085

NPI assigned

Jun 19, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Lawrence Richard Jackson Jr., MDNPI 1386794816

Title

Owner

Phone

(931) 296-3555

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

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

• Lawrence Richard Jackson Jr., MD

  • Family Medicine Physician
  • Waverly, TN
  • NPI 1386794816
  Medicare reassignment Care Compare group NPD Authorized official
• Karen Michelle Dixon, FNP-C

  • Family Medicine Physician
  • Waverly, TN
  • NPI 1992569206
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1182211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763683200000",
    "number": "1104021203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "371850270",
            "telephone_number": "931-296-3555",
            "fax_number": "931-296-9085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 HILLWOOD DR",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "371852116",
            "telephone_number": "931-296-3555",
            "fax_number": "931-296-9085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAWRENCE RICHARD JACKSON JR. MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-19",
        "last_updated": "2025-11-21",
        "certification_date": "2025-11-21",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "931-296-3555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3724150",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anthony Glenn Kimbro, LPC PRE-LICENSE
• King Family Medical PLLC
• Christie Madge King-Patterson, NP-C
• James H King, O.D.
• Ernest Bobby Kleier Jr., MD
• Linda Cleo Leonard, RPH
• Carolyn D Lewallen
• Lifeguard Ambulance Service LLC
• Rebecca Loatwall, FNP-C
• Magnolia Meadows LLC

• Family Medicine Physician in Waverly, TN
• Providers in Waverly, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.