Individual
DR. JACKSON L GATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1880 LANCASTER DRIVE, CONYERS, GA 30013-6433
(678) 591-6509
Mailing address
777 CLEVELAND AVE SW, SUITE 100, ATLANTA, GA 30315-7129
(404) 763-0093
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
038767
GA
208D00000X
General Practice Physician
Primary
038767
GA
Other
Enumeration date
08/01/2006
Last updated
08/10/2010
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