Lawrence Richard Jackson in Waverly, TN - Medicare Family Medicine

Lawrence Richard Jackson is a medicare enrolled primary clinic (Family Medicine) in Waverly, Tennessee. The current practice location for Lawrence Richard Jackson is 102 Hillwood Dr, Waverly, Tennessee. For appointments, you can reach them via phone at (931) 296-3555. The mailing address for Lawrence Richard Jackson is Po Box 270, Waverly, Tennessee and phone number is (931) 296-3555.

Lawrence Richard Jackson is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1104021203. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (931) 296-3555.

Contact Information

	Lawrence Richard Jackson
	102 Hillwood Dr Waverly TN 37185-2116
	(931) 296-3555
	(931) 296-9085

Map and Direction

Primary Care Clinic Profile

Full Name	Lawrence Richard Jackson
Speciality	Family Medicine
Location	102 Hillwood Dr, Waverly, Tennessee
Authorized Official Name and Position	Lawrence Richard Jackson (OWNER)
Authorized Official Contact	9312963555
Accepts Medicare Insurance	Yes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Lawrence Richard Jackson Po Box 270 Waverly TN 37185-0270 Ph: (931) 296-3555	Lawrence Richard Jackson 102 Hillwood Dr Waverly TN 37185-2116 Ph: (931) 296-3555

NPI Details:

NPI Number	1104021203
Provider Enumeration Date	06/19/2007
Last Update Date	01/29/2008

Medicare PECOS Information:

Medicare PECOS PAC ID	1557350154
Medicare Enrollment ID	O20040510000335

Medical Identifiers

Medical identifiers for Lawrence Richard Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1104021203	NPI	-	NPPES
3724150	Medicaid	TN

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207Q00000X	Family Medicine	(* (Not Available))	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Lawrence Richard Jackson acts as a billing entity for following providers:

Provider Name	Lawrence R Jackson
Provider Type	Practitioner - Family Practice
Provider Identifiers	NPI Number: 1386794816 PECOS PAC ID: 5698764298 Enrollment ID: I20090702000018

Reviews and Comments

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Lawrence Richard Jackson - Medicare Primary Care in Waverly, TN