Henry Jackson
Internal Medicine in Augusta, GA. Individual provider (NPI-1).
NPI number1285643452
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1285643452
- Entity type
- Individual (NPI-1)
- Name
- Henry Jackson
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 5, 2006
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | 020320 | GA | Yes |
Practice location
1 Freedom WayVamc-Augusta-Ud (26)
Augusta, GA 30904-6258
Phone 706-733-0188
Mailing address
Po Box 3677Augusta, GA 30914-3677
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