Provider Demographics
NPI:1619915824
Name:JACOBS, WILLIAM SOLOMON JR (M D)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SOLOMON
Last Name:JACOBS
Suffix:JR
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1499 WALTON WAY STE 1400
Mailing Address - Street 2:ATTN: DONNA RAIFORD
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2603
Mailing Address - Country:US
Mailing Address - Phone:706-828-8402
Mailing Address - Fax:706-721-1793
Practice Address - Street 1:997 ST. SEBASTIAN WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2603
Practice Address - Country:US
Practice Address - Phone:706-721-6597
Practice Address - Fax:706-721-1793
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA071681207L00000X, 207LA0401X, 207LP2900X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000291101C,DMedicaid
GA071681OtherGA LICENSES
GAAJ2717291OtherDEA
GAAJ2717291OtherDEA
GAAJ2717291OtherDEA