Provider Demographics
NPI:1225214745
Name:JACKSON, JERMAINE M (MD)
Entity Type:Individual
Prefix:
First Name:JERMAINE
Middle Name:M
Last Name:JACKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2045 PEACHTREE RD NE
Mailing Address - Street 2:SUITE T-1
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1414
Mailing Address - Country:US
Mailing Address - Phone:404-350-0009
Mailing Address - Fax:404-350-0280
Practice Address - Street 1:2045 PEACHTREE RD NE
Practice Address - Street 2:SUITE T-1
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1414
Practice Address - Country:US
Practice Address - Phone:404-350-0009
Practice Address - Fax:404-350-0280
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2016-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA060278207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease