| Lawrence Richard Jackson Jr, MD | |
|
104 Hillwood Dr, Waverly, TN 37185-2116 | |
| (931) 296-3555 | |
| (931) 296-9085 |
| Full Name | Lawrence Richard Jackson Jr |
|---|---|
| Gender | Male |
| Speciality | Family Practice |
| Experience | 39 Years |
| Location | 104 Hillwood Dr, Waverly, Tennessee |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386794816 | NPI | - | NPPES |
| 223121700 | Other | TN | DEPT OF LABOR |
| 0151975 | Other | TN | BCBS |
| 3724150 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20215 (Tennessee) | Secondary |
| 207Q00000X | Family Medicine | MD0000020215 (Tennessee) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Home Care Solutions | Nashville, TN | Home health agency |
| Tennessee Quality Care - Home Health | Parsons, TN | Home health agency |
| Amedisys Home Health | Nashville, TN | Home health agency |
| Three Rivers Hospital | Waverly, TN | Hospital |
| Tristar Horizon Medical Center | Dickson, TN | Hospital |
| Saint Thomas West Hospital | Nashville, TN | Hospital |
| Humphreys County Care And Rehabilitation | Waverly, TN | Nursing home |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Lawrence Richard Jackson | 1557350154 | 2 |
| Entity Name | Lawrence Richard Jackson |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1104021203 PECOS PAC ID: 1557350154 Enrollment ID: O20040510000335 |
| Entity Name | Humphreys County Community Health Services, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1235387044 PECOS PAC ID: 9931276359 Enrollment ID: O20090415000457 |
| Entity Name | Concord Medical Group Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1083630610 PECOS PAC ID: 0446296818 Enrollment ID: O20151006000818 |
| Entity Name | South Central Physicians Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1427611854 PECOS PAC ID: 6507195492 Enrollment ID: O20190830001905 |
| Mailing Address | Practice Location Address |
|---|---|
| Lawrence Richard Jackson Jr, MD Po Box 270, Waverly, TN 37185-0270 Ph: (931) 296-3555 | Lawrence Richard Jackson Jr, MD 104 Hillwood Dr, Waverly, TN 37185-2116 Ph: (931) 296-3555 |
Tiffany Renee Bagwell, APRN, NP-C Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 209 W Main St, Waverly, TN 37185 Phone: 931-209-7033 | |
Mrs. Karen Michelle Dixon, FNP-C Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 102 Hillwood Dr, Waverly, TN 37185 Phone: 931-296-3555 Fax: 931-296-9085 |