Provider Demographics
NPI:1710913280
Name:ACHILLES, JACKSON TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:TODD
Last Name:ACHILLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 PULLIAM ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76905-5148
Mailing Address - Country:US
Mailing Address - Phone:325-658-6138
Mailing Address - Fax:
Practice Address - Street 1:2018 PULLIAM ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76905-5148
Practice Address - Country:US
Practice Address - Phone:325-658-6138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE82802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123191205Medicaid
TXE8280OtherMEDICAL LICENSE
TX8C6154Medicare PIN