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General NPI Number Information
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NPI Number | 1982185443
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Entity Type | Individual
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Provider Name | CHRISTOPHE EUGENE JACKSON PA
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Gender | Male
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Dates
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Enumeration Date | 08/23/2018
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 2001 PEACHTREE RD NE STE 575
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City | ATLANTA
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State | GA
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Zip | 30309-1476
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Country | US
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Telephone | 678-904-7158
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Fax |
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Provider Business Mailing Address
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Address Line | 10099 RIDGEGATE PKWY STE 480
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City | LONE TREE
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State | CO
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Zip | 80124-5537
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Country | US
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Telephone | 720-599-3074
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Fax | 720-360-1195
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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 | 2084A2900X
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Taxonomy Name | Neurocritical Care Physician
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License Number | 80827
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9212
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 2084A2900X
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Taxonomy Name | Neurocritical Care Physician
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License Number | PA0006179
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 8683
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License Number State | WI
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