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General NPI Number Information
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NPI Number | 1063828416
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Entity Type | Individual
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Provider Name | RHONDA RENEE JACKSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 156 FOSTER DR SPC C
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City | MCDONOUGH
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State | GA
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Zip | 30253-5346
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Country | US
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Telephone | 770-968-9978
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Fax | 770-968-9975
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Provider Business Mailing Address
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Address Line | 156 FOSTER DR SPC C
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City | MCDONOUGH
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State | GA
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Zip | 30253-5346
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Country | US
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Telephone | 770-968-9978
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Fax | 770-968-9975
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD468479
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 4301105792
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 85286
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 92856
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License Number State | GA
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