Provider Demographics
NPI:1518947456
Name:JACOBSON, ROSS LANG (MD)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:LANG
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-297-2200
Practice Address - Fax:770-534-8139
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057204207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA238806338AMedicaid
GA4346566OtherCIGNA
GA238806338CMedicaid
GA238806338DMedicaid
GA0677272OtherUNITED HEALTHCARE
GA238806338EMedicaid
GA52197850OtherBCBS
GA10038639OtherAMERIGROUP
GA340853OtherWELLCARE
GA238806338BMedicaid
GA4069685OtherAETNA
GA238806338CMedicaid
GA238806338BMedicaid