Lawrence Richard Jackson Jr. MD
NPI 1104021203ActiveOrganization· Family Medicine· Waverly, TN
Family Medicine in Waverly, Tennessee, registered in NPPES in June 2007. The authorized official on file is Lawrence Richard Jackson, MD, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1104021203 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jun 19, 2007 |
| Last updated in NPPES | Nov 21, 2025 |
| Certified by provider | Nov 21, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine Primary | 207Q00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (TN) |
|---|
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