Individual
MR. ANTONIO TERELL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1364 CLIFTON RD NE, ATLANTA, GA 30322-1059
(404) 727-5658
Mailing address
1364 CLIFTON RD NE, ATLANTA, GA 30322-1059
(404) 727-5658
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
96738
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/02/2022
Last updated
04/16/2025
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