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LAWRENCE RICHARD JACKSON JR. MD
NPI 1104021203
Family Medicine in Waverly, TN

Active since June 19, 2007CLIA 44D0914968 · Waiver
104 HILLWOOD DR, WAVERLY, TN 37185(931) 296-3555(931) 296-9085 Get Directions Write a Review

NPPES record last updated: November 21, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Lawrence Richard Jackson Jr. Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LAWRENCE RICHARD JACKSON JR. MD (NPI 1104021203) is a healthcare organization registered as a family medicine in Waverly, Tennessee and active in the NPI registry since June 2007. The organization holds a CLIA Waiver certificate valid through May 14, 2028 and lists Lawrence Richard Jackson, Owner, as its authorized official.

NPPES Registry Identity

NPI1104021203
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameLAWRENCE RICHARD JACKSON JR. MD
Location Address104 HILLWOOD DRWaverly, TN 37185-2116
Mailing AddressPo Box 270Waverly, TN 37185-0270 · (931) 296-3555 · Fax (931) 296-9085
Phone(931) 296-3555
Fax(931) 296-9085
Organization SubpartNo
Authorized OfficialLawrence Richard JacksonOwner · (931) 296-3555
Enumeration DateJune 19, 2007
Last NPPES UpdateNovember 21, 2025
NPPES CertifiedNovember 21, 2025
✔ NPI 1104021203 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
104 HILLWOOD DR, Waverly, TN 37185
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Other Identifiers 1

Medicaid3724150TN

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Magnolia Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 44D0914968

Lawrence Richard Jackson Jr MD · Waverly, TN
Active · expires May 14, 2028
CLIA Number44D0914968
Laboratory TypePhysician Office
Certificate Effective DateMay 15, 2026
Certificate Expiration DateMay 14, 2028
Laboratory DirectorLawrence R. Jackson Jr MD
Laboratory Phone(615) 296-3555
Laboratory LocationLawrence Richard Jackson Jr MD104 Hillwood Dr, Waverly, TN 37185
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LAWRENCE RICHARD JACKSON JR. MD
Family Medicine
104 HILLWOOD DR
WAVERLY, TN 37185
Humphreys County (931) 296-3555
MRS. JENNIFER LEE GERBER F.N.P.
Nurse Practitioner (Family)
104 HILLWOOD DR
WAVERLY, TN 37185
Humphreys County (931) 296-7052

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lawrence Richard Jackson Jr. MD's NPI number?

The NPI number for Lawrence Richard Jackson Jr. MD is 1104021203. It was assigned to this organization in the NPPES registry on June 19, 2007.

Where is Lawrence Richard Jackson Jr. MD located?

Lawrence Richard Jackson Jr. MD is located at 104 Hillwood Dr, Waverly, TN 37185. The listed phone number is (931) 296-3555.

What is Lawrence Richard Jackson Jr. MD's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Lawrence Richard Jackson Jr. MD hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 44D0914968) is associated with this NPI, valid through May 14, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Lawrence Richard Jackson Jr. MD accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Magnolia Health, Ambetter of Alabama and Ambetter of North Carolina and 1 other insurer list Lawrence Richard Jackson Jr. MD as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Lawrence Richard Jackson Jr. MD was last updated on November 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.