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General NPI Number Information
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NPI Number | 1164406252
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Entity Type | Individual
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Provider Name | HAROLD DAMON JACKSON MD
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Gender | Male
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 2665 N DECATUR RD SUITE 430
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City | DECATUR
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State | GA
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Zip | 30033-6149
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Country | US
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Telephone | 404-294-4018
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Fax | 404-294-1359
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Provider Business Mailing Address
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Address Line | 2665 N DECATUR RD SUITE 430
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City | DECATUR
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State | GA
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Zip | 30033-6149
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Country | US
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Telephone | 404-294-4018
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Fax | 404-294-1359
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 032591
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 032591
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License Number State | GA
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