Individual
RALPH A JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4390 PLEASANT HILL RD STE D, DULUTH, GA 30096-8054
(770) 476-2273
(770) 476-2274
Mailing address
4390 PLEASANT HILL RD STE D, DULUTH, GA 30096-8054
(770) 476-2273
(770) 476-2274
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
022794
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00240545L
—
GA
01
—
582396298
TAX ID
GA
Enumeration date
09/15/2006
Last updated
07/11/2012
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