Individual
KEVIN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
800 MOUNT VERNON HWY NE STE 130, ATLANTA, GA 30328-4293
(404) 256-1125
Mailing address
906 WEDGEWOOD TER, WESTMINSTER, MD 21158-3654
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
95793
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/09/2019
Last updated
09/20/2023
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