| Northcrest Family Medicine Llc | |
|
7768 Cumming Hwy Suite 300 Canton GA 30114-9314 | |
| (770) 720-2113 | |
| (770) 704-7365 |
| Full Name | Northcrest Family Medicine Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 7768 Cumming Hwy, Canton, Georgia |
| Authorized Official Name and Position | John Richard Jackson (MD / OWNER) |
| Authorized Official Contact | 7706551408 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northcrest Family Medicine Llc 7768 Cumming Hwy. Ste 300 Canton GA 30114 Ph: (770) 720-2113 | Northcrest Family Medicine Llc 7768 Cumming Hwy Suite 300 Canton GA 30114-9314 Ph: (770) 720-2113 |
| NPI Number | 1255465217 |
|---|---|
| Provider Enumeration Date | 03/14/2007 |
| Last Update Date | 03/22/2013 |
| Medicare PECOS PAC ID | 1456371236 |
|---|---|
| Medicare Enrollment ID | O20051123000428 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255465217 | NPI | - | NPPES |
| 978224987A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 056102 (Georgia) | Primary |
| Provider Name | John Richard Jackson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1457350902 PECOS PAC ID: 0446270128 Enrollment ID: I20051128000141 |
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