Individual
DR. HAROLD DAMON JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2665 N DECATUR RD, SUITE 430, DECATUR, GA 30033-6149
(404) 294-4018
(404) 294-1359
Mailing address
2665 N DECATUR RD, SUITE 430, DECATUR, GA 30033-6149
(404) 294-4018
(404) 294-1359
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
032591
GA
207RP1001X
Pulmonary Disease Physician
Primary
032591
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00421363D
—
GA
01
—
0932200001
WORKERS COMPENSATION
GA
01
—
110089544
RAILROAD MEDICARE
GA
01
—
1164406252
NPI
GA
01
—
2598499
GHI
—
01
—
4365944
AETNA
—
01
—
479614
BLUE CROSS BLUE SHIELD
GA
01
—
4806794
UNITED HEALTHCARE
—
01
—
5931
KAISER
GA
01
—
6613810008
CIGNA
—
Enumeration date
12/01/2005
Last updated
01/27/2010
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