Provider Demographics
NPI:1467489476
Name:THOMPSON, JACKIE COX (MD)
Entity Type:Individual
Prefix:DR
First Name:JACKIE
Middle Name:COX
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:J
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2927 DEMERE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-1620
Mailing Address - Country:US
Mailing Address - Phone:912-638-1999
Mailing Address - Fax:912-634-8416
Practice Address - Street 1:2927 DEMERE RD
Practice Address - Street 2:
Practice Address - City:SAINT SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-1620
Practice Address - Country:US
Practice Address - Phone:912-638-1999
Practice Address - Fax:912-634-8416
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0124462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD45140Medicare UPIN
GA26BDKJRMedicare ID - Type Unspecified