Healthcare Provider Details

I. General information

NPI: 1225664212
Provider Name (Legal Business Name): ALRICKA JOLYNN JACKSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E 66TH ST
SAVANNAH GA
31405-4519
US

IV. Provider business mailing address

142 BERNHARD RD
FAYETTEVILLE GA
30215-3074
US

V. Phone/Fax

Practice location:
  • Phone: 912-662-0088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number98878
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number98878
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: