Provider Demographics
NPI:1942406483
Name:ACKERMAN, JEREMY DAVID (MD PHD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:DAVID
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 ASBURY CIR STE N340
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1006
Mailing Address - Country:US
Mailing Address - Phone:404-778-5975
Mailing Address - Fax:404-778-2630
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1059
Practice Address - Country:US
Practice Address - Phone:404-778-5975
Practice Address - Fax:404-778-2630
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244593207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine