Ralph L Jackson, DDS
Individual provider Active NPI General Practice Dentistry · Cornelia, GA
NPI 1508869231 · NPPES record last updated Mar 11, 2009
Key facts
- NPI
- 1508869231
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- GA009940 (GA)
- Practice address
- 105 Highland Ave
Cornelia, GA 30531-4366 - Phone
- (706) 778-8645
- Fax
- (706) 776-2650
- NPI assigned
- May 26, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| GA009940 | GA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cornelia Dental, LLC | Past | Accepting new patients | |
| Ralph L. Jackson, DDS, PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | GA009940 | GA | Yes |
Addresses
Primary practice location
105 Highland Ave
Cornelia, GA 30531-4366
Mailing address
105 Highland Ave
Cornelia, GA 30531-4366
Phone (706) 778-8645
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- James Monroe Colston
- Rosmery Del Carmen Jimenez de Rodriguez
- Kimberly B Kaminski
- Kathryn Kaplan Kelly
- Tarek John Kerbage
All providers in Cornelia, GA · General Practice Dentistry in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2009. 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.