Provider Demographics
NPI:1811951593
Name:JACOBSON, MARTIN A (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:A
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 1:1410 BACON PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2008
Mailing Address - Country:US
Mailing Address - Phone:843-240-2802
Mailing Address - Fax:
Practice Address - Street 1:1410 BACON PARK DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2008
Practice Address - Country:US
Practice Address - Phone:843-240-2802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20613207Q00000X
GA062364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA305678198BMedicaid
GAP00778515OtherRR MEDICARE
GA305678198AMedicaid
GA582203199-009OtherTRICARE
SC206137Medicaid
GA582203199-004OtherTRICARE
GA582203199-004OtherTRICARE
GAP00778515OtherRR MEDICARE