Healthcare Provider Details

I. General information

NPI: 1982185443
Provider Name (Legal Business Name): CHRISTOPHE EUGENE JACKSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 PEACHTREE RD NE STE 575
ATLANTA GA
30309-1476
US

IV. Provider business mailing address

10099 RIDGEGATE PKWY STE 480
LONE TREE CO
80124-5537
US

V. Phone/Fax

Practice location:
  • Phone: 678-904-7158
  • Fax:
Mailing address:
  • Phone: 720-599-3074
  • Fax: 720-360-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number80827
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9212
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberPA0006179
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8683
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: