Provider Demographics
NPI:1164406252
Name:JACKSON, HAROLD DAMON (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:DAMON
Last Name:JACKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2665 N DECATUR RD
Mailing Address - Street 2:SUITE 430
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6149
Mailing Address - Country:US
Mailing Address - Phone:404-294-4018
Mailing Address - Fax:404-294-1359
Practice Address - Street 1:2665 N DECATUR RD
Practice Address - Street 2:SUITE 430
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6149
Practice Address - Country:US
Practice Address - Phone:404-294-4018
Practice Address - Fax:404-294-1359
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA032591207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1164406252OtherNPI
GA00421363DMedicaid
4365944OtherAETNA
GA110089544OtherRAILROAD MEDICARE
4806794OtherUNITED HEALTHCARE
GA5931OtherKAISER
GA0932200001OtherWORKERS COMPENSATION
GA479614OtherBLUE CROSS BLUE SHIELD
6613810008OtherCIGNA
2598499OtherGHI
2598499OtherGHI
4365944OtherAETNA