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Individual

TERENCE JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1439 JESSE JEWELL PKWY NE STE 302, GAINESVILLE, GA 30501-3806
(770) 219-9200
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
35.136105
OH
208600000X
Surgery Physician
Primary
95954
GA
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
07/20/2013
Last updated
10/18/2023
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