Provider Demographics
NPI:1326290578
Name:JACKSON T. ACHILLES, MD PA
Entity Type:Organization
Organization Name:JACKSON T. ACHILLES, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:ACHILLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-838-1116
Mailing Address - Street 1:810 HOSPITAL DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4600
Mailing Address - Country:US
Mailing Address - Phone:409-838-1116
Mailing Address - Fax:409-838-0516
Practice Address - Street 1:810 HOSPITAL DR
Practice Address - Street 2:SUITE 320
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4600
Practice Address - Country:US
Practice Address - Phone:409-838-1116
Practice Address - Fax:409-838-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE82802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty