Henry Jackson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN015907 Issued in GA

Practice address

55 Glenda Trce
Newnan, GA 30265-3887

Phone

(770) 252-4466

NPI assigned

Jul 25, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1564012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564012800000",
    "number": "1871147116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 W COVE DR",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302636370",
            "telephone_number": "678-877-5423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 GLENDA TRCE",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302653887",
            "telephone_number": "770-252-4466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "HENRY",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-25",
        "last_updated": "2019-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN015907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GENERAL PRACTICE",
            "identifier": "DN015907",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christine E Issa, RD
• Itsmeannb,LLC
• Victoria Ivens, DPT
• Crista Jonte' Ivory, NP
• Elizabeth A. Jackson, NP-C
• Lewis W. Jackson, M.D.
• Malasia Jackson, RBT
• Mallory Charlene Jackson
• Melvin Jackson, NP
• Sandra Lynne Jackson, LPC

• General Practice Dentistry in Newnan, GA
• Providers in Newnan, 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 Jul 25, 2019; 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.