Basic Information
| Provider Information | |||||||||
| NPI: | 1497253835 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACKSON | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | BOYD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1465 LANEY WALKER BLVD | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309120002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067212613 | ||||||||
| FaxNumber: | 2762096690 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 W HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | FORT GORDON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309055741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067875811 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2018 | ||||||||
| LastUpdateDate: | 08/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 87351 | GA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.