Kezia Anila Jacob, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

058964 Issued in NY

Practice address

159 Altama Connector
Brunswick, GA 31525

Phone

(912) 264-8408

NPI assigned

Jun 15, 2015

Last updated

May 26, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Howard Family Dental-Brunswick, LLC

  • General Practice Dentistry
  • Brunswick, GA
  • NPI 1194843219
  NPD (past)

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

{
    "created_epoch": "1434326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527292800000",
    "number": "1497136550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 ALTAMA CONNECTOR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315251853",
            "telephone_number": "540-239-2943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 ALTAMA CONNECTOR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "31525",
            "telephone_number": "912-264-8408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOB",
        "first_name": "KEZIA",
        "middle_name": "ANILA",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-15",
        "last_updated": "2018-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "058964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenna L. Jackson
• Jennifer Jackson, RN
• Kierra Jackson
• Loretta Patrice Jackson, LCSW
• Sherkeith Jackson
• Kiara Jacobs
• Sandra Jacobs
• James W Greene MD LLC
• Timothy A Jamieson, MD
• Karen Jarocki

• Dentist in Brunswick, GA
• Providers in Brunswick, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.