Individual
LEOPOLD L JACKSON
Active
Individual
LEOPOLD L JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
047224
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000824216L
—
GA
05
—
000824216M
—
GA
01
—
1881631984
NPI
GA
01
—
1982637419
GROUP NPI
GA
01
—
300966
WELLCARE MEDICAID
GA
01
—
587007
BCBSGA (NSC)
GA
01
—
858272
BCBSGA (AMC)
GA
01
—
P00251519
RAILROAD MEDICARE
—
Enumeration date
05/31/2006
Last updated
12/20/2010
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