Individual
THERESA R JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
868 YORK AVE SW, ATLANTA, GA 30310-2750
(404) 752-1400
(404) 758-0740
Mailing address
868 YORK AVE SW, ATLANTA, GA 30310-2750
(404) 752-1400
(404) 758-0740
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
046864
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000873188A
—
GA
Enumeration date
03/29/2006
Last updated
02/20/2014
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