Laverne Jackson
Individual provider Active NPI Primary Care Clinic/Center · Quitman, GA
NPI 1134593353 · NPPES record last updated Nov 27, 2015
Key facts
- NPI
- 1134593353
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- License
- RN130090 (GA)
- Practice address
- 903 N Court St
Quitman, GA 31643-1315 - Phone
- (229) 263-7147
- Fax
- (229) 263-6318
- NPI assigned
- Nov 27, 2015
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN130090 | GA | MD | Primary Care Clinic/Center |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | RN130090 | GA | Yes |
Addresses
Primary practice location
903 N Court St
Quitman, GA 31643-1315
Mailing address
903 N Court St
Quitman, GA 31643-1315
Phone (229) 263-7147
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RN130090 | Other | GA | PROFESSIONAL REGISTERED NURSE |
Other providers in Quitman, GA
- Michael William Harrell
- Jennifer H Hightower
- Ryan Hudson
- Ramsey B Hughes
- J.H. Harvey Co., LLC
- Melissa Jenkins
- Robert Eugene Jennings Jr.
- Robyn E Jimenez
- John D. Archbold Memorial Hospital
- John D. Archbold Memorial Hospital, Inc.
All providers in Quitman, GA · Primary Care Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.