Individual
DR. REGINALD ROBERTS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
35 COLLIER RD NW, SUITE 635, ATLANTA, GA 30309
(404) 367-3014
(404) 367-3558
Mailing address
PO BOX 102321, ATLANTA, GA 30368
(404) 367-3014
(404) 367-3558
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
051007
GA
208M00000X
Hospitalist Physician
Primary
051007
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00932896A
—
GA
Enumeration date
09/15/2006
Last updated
05/29/2024
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