Jackson, Michael S
Jackson, Michael S is an sole proprietor health care provider with primary practice located at 506 Riverside Pkwy Ne Ste 200, Rome GA 30161-2902. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Jackson, Michael S can be contacted via phone (706) 266-2383.Contact Information
Primary practice address
506 Riverside Pkwy Ne Ste 200
Rome GA 30161-2902
Phone: (706) 266-2383
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 055376 | Georgia |
Profile Details
| NPI number | 1306830062 |
|---|---|
| LBN Legal business name | Jackson, Michael S |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 8th, 2005 |
| Last updated | Aug 12th, 2019 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306830062 | NPPES |
| Georgia | MEDICAID | 000807474D | |
| Georgia | Other | 1164745782 | |
| Georgia | Other | 202I080352 | |
| Georgia | MEDICAID | 000807474B | |
| Georgia | MEDICAID | 000807474C | |
| Georgia | Other | 1306830062 |
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