Rollin B Jackson III, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN013091 Issued in GA

Practice address

1718 N Coastal Hwy
Midway, GA 31320-3415

Phone

(912) 880-2288

Fax

(912) 880-2110

NPI assigned

Feb 13, 2007

Last updated

Nov 9, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Midway Family Dental

  dba RB Jackson, III DMD

  • General Practice Dentistry
  • Midway, GA
  • NPI 1780043000
  NPD (past) Authorized official

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478649600000",
    "number": "1306988571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 134",
            "city": "MIDWAY",
            "state": "GA",
            "postal_code": "313200134",
            "telephone_number": "912-880-2288",
            "fax_number": "912-880-2110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1718 N COASTAL HWY",
            "city": "MIDWAY",
            "state": "GA",
            "postal_code": "313203415",
            "telephone_number": "912-880-2288",
            "fax_number": "912-880-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "ROLLIN",
        "middle_name": "B",
        "name_suffix": "III",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2016-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN013091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Waters Holliday, M.ED, CCC-SLP
• Hospital Authority of Liberty County (Liberty Regional Medical Associates Primary Care-Midway Campus)
• Insightful Soulutions Life Coach
• Sanquell-la'Shae Ivory
• Angela Jackson
• Gloria Delores Johnson, COTA
• Shonda King, TRICHOLOGY
• Cheryl Elaine Lamb, AMFT
• Liberty Orthopaedic Associates
• Liberty Regional Medical Center Inc (Liberty Regional Orthopaedics)

• General Practice Dentistry in Midway, GA
• Providers in Midway, 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 Nov 9, 2016; 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.