Healthcare Provider Details

I. General information

NPI: 1578053138
Provider Name (Legal Business Name): JAYSON TRIPP DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COLONIAL CENTER PKWY STE 350
ROSWELL GA
30076-4893
US

IV. Provider business mailing address

1501 N GILBERT RD STE 206
GILBERT AZ
85234-2394
US

V. Phone/Fax

Practice location:
  • Phone: 678-861-1832
  • Fax: 678-585-2259
Mailing address:
  • Phone: 480-626-7584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS015504
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS19034
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number98893
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberT9036
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number12306263-1204
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2020-03587
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number009117
License Number StateAZ
# 8
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR.0066525
License Number StateCO
# 9
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberCL0305
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: