Provider Demographics
NPI:1235361908
Name:JACKSON P. MORGAN, III, PC
Entity Type:Organization
Organization Name:JACKSON P. MORGAN, III, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:P
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:912-355-9330
Mailing Address - Street 1:4700 WATERS AVE
Mailing Address - Street 2:SUITE 504
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-355-9330
Mailing Address - Fax:
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:SUITE 504
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-355-9330
Practice Address - Fax:912-355-9355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0116061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000780766AMedicaid
U49937Medicare UPIN
GA000780766AMedicaid