Provider Demographics
NPI:1376546549
Name:JACOBSON, MICHAEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:JACOBSON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1100 JOHNSON FERRY RD NE
Mailing Address - Street 2:SUITE 593
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1709
Mailing Address - Country:US
Mailing Address - Phone:404-255-9096
Mailing Address - Fax:404-255-9097
Practice Address - Street 1:1100 JOHNSON FERRY RD NE
Practice Address - Street 2:SUITE 593
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1709
Practice Address - Country:US
Practice Address - Phone:404-255-9096
Practice Address - Fax:404-255-9097
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2010-02-12
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Provider Licenses
StateLicense IDTaxonomies
GA034163207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD88876Medicare UPIN