Healthcare Provider Details

I. General information

NPI: 1245282037
Provider Name (Legal Business Name): WILLIAM A J ALEXANDER JACKSON ROSS JR JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 UPPER RIVERDALE RD SW STE 112
RIVERDALE GA
30274-2642
US

IV. Provider business mailing address

1920 NISKEY LAKE TRL SW
ATLANTA GA
30331-6326
US

V. Phone/Fax

Practice location:
  • Phone: 770-897-7874
  • Fax:
Mailing address:
  • Phone: 404-344-9755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number52433
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number047650
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: