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Individual

DR. TANJELA M JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
3620 M L KING JR DR SW, ATLANTA, GA 30331-3711
(404) 696-7300
(404) 699-3514
Mailing address
3620 MARTIN LUTHER KING JR DR SW, ATLANTA, GA 30331-3711
(404) 696-7300

Taxonomy

Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
054755
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2490487
UNITED HEALTH CARE
GA
01
52152577
BCBS
GA
01
7368440
CIGNA
GA
05
748360477
GA
05
748360477E
GA
05
748360477F
GA
05
748360477G
GA
05
748360477H
GA
05
748360477I
GA
05
748360477J
GA
05
748360477K
GA
01
7889745
AETNA
GA
Enumeration date
10/11/2005
Last updated
12/16/2020
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