Healthcare Provider Details

I. General information

NPI: 1093638595
Provider Name (Legal Business Name): KRYSTAL TOMSKY-JACKSON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 W CAMPGROUND RD
MCDONOUGH GA
30253-8034
US

IV. Provider business mailing address

128 KING RICHARD DR
GRIFFIN GA
30223-8812
US

V. Phone/Fax

Practice location:
  • Phone: 404-689-0058
  • Fax:
Mailing address:
  • Phone: 478-213-3690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY900332
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY900332
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: