DR. BETHANY WALL JACKSON M.D. NPI 1033396841

NPI Information

  • NPI: 1033396841
  • Provider Name: DR. BETHANY WALL JACKSON, M.D.
  • Classification: Pediatrics - 208000000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 2112 SHORTER AVE NW STE 240
    ROME, GA
    ZIP 30165
  • Phone: (706) 368-8575

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NPI Details

DR. Bethany Wall Jackson, M.D. is a pediatrics in Rome, GA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. DR. Bethany Wall Jackson, M.D. NPI is 1033396841. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

2112 SHORTER AVE NW STE 240
ROME, GA
ZIP 30165-042
Phone: (706) 368-8575
Fax: (706) 204-9430

The NPI 1033396841 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/23/2008 and was last updated on 4/16/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatrics060642GEORGIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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