Jackson Family Dentistry PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9939 Issued in GA

Legal business name

JACKSON FAMILY DENTISTRY PC

Practice address

2009 Tebeau Street
Waycross, GA 31501

Phone

(912) 283-1340

Fax

(912) 283-0334

NPI assigned

Mar 6, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Andrew Lee Jackson, DMD

Title

Owner President

Phone

(912) 283-1340

Specialties & licenses 2

Addresses

Other names 1

• Dr Andrew Lee Jackson DMD Dr Celestine Vernedoe DMD Other name

Locations

Practitioners 1

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

• Celestine Varnedoe, DMD

  • General Practice Dentistry
  • Waycross, GA
  • NPI 1114056835
  NPD (past)

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202774400000",
    "number": "1124157847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2009 TEBEAU STREET",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "31501",
            "telephone_number": "912-283-1340",
            "fax_number": "912-283-0334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2009 TEBEAU STREET",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "31501",
            "telephone_number": "912-283-1340",
            "fax_number": "912-283-0334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON FAMILY DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2008-02-12",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "912-283-1340",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "9939",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "9840",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr Andrew Lee Jackson DMD Dr Celestine Vernedoe DMD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Integrity Long Term Care LLC
• Internal Medicine Associates of Waycross, P.C.
• Ahmad Irfan, M.D.
• Iveta Berzinch MD PC
• J H Harvey Co LLC
• Carmen Yolanda Jackson, FNP
• Maria Shauntee Jackson
• Jacobs Clinic, Inc.
• Hamley Jacobs
• John Franklin Jacobs, PHYSICIAN ASSISTANT

• General Practice Dentistry in Waycross, GA
• Providers in Waycross, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2008; 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.