NPIMap

Organization Active NPI

K Jackson DMD PC

  • General Practice Dentistry
  • Lagrange, GA
National Provider Identifier
1952447153
Registry record updated Aug 22, 2020
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Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN011604 Issued in GA
Legal business name
K JACKSON DMD PC
Practice address
204 Smith St
Lagrange, GA 30240-2744
Phone
(706) 884-4254
NPI assigned
Jan 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Karen A Jackson, DMD
Title
Dentist Owner
Phone
(706) 884-4254

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X DN011604 GA Primary

Addresses

Primary practice location

204 Smith St
Lagrange, GA 30240-2744

Mailing address

204 Smith St
Lagrange, GA 30240-2744
Phone (706) 884-4254

National Provider Directory

National Provider Directory

Locations

204 Smith St
Lagrange, GA 30240
Phone (706) 884-4254

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1952447153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 SMITH ST",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302402744",
            "telephone_number": "706-884-4254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 SMITH ST",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302402744",
            "telephone_number": "706-884-4254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K JACKSON DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DENTIST OWNER",
        "authorized_official_telephone_number": "706-884-4254",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN011604",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lagrange, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.