Provider Demographics
NPI:1427132588
Name:JACOBS, RICHARD LEE II (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
Last Name:JACOBS
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 SHELL TOOMER PKWY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-6950
Mailing Address - Country:US
Mailing Address - Phone:919-407-2835
Mailing Address - Fax:
Practice Address - Street 1:1595 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2353
Practice Address - Country:US
Practice Address - Phone:919-407-2835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99-00071207L00000X
FLME111625207L00000X
GA66955207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911863Medicaid
NC2263526Medicare PIN
E94979Medicare UPIN