Provider Demographics
NPI:1821627225
Name:JACKSON, TODD JR (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:
Last Name:JACKSON
Suffix:JR
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 HILLTOP DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-6019
Mailing Address - Country:US
Mailing Address - Phone:404-983-5256
Mailing Address - Fax:
Practice Address - Street 1:5665 NEW NORTHSIDE DR STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4617
Practice Address - Country:US
Practice Address - Phone:404-778-5975
Practice Address - Fax:404-778-2630
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA90618207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine