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NPI Code Detail

MEDICARE: RAMSEY ELLIOTT JACKSON M.D.

MEDICARE:   RAMSEY ELLIOTT JACKSON  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0300XGeriatric Medicine (Internal Medicine) Physician047774GA

General Provider Information

NPI Number : 1275645459
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAMSEY ELLIOTT JACKSON M.D.
Provider Business Mailing Address
First Line : 3904 N DRUID HILLS RD
Second Line : #222
City : DECATUR
State : GA
Zip : 30033-3105
Country : US
Telephone Number : 770-458-1594
Fax Number : 770-458-1596
Provider Business Practice Location Address
First Line : 2650 WEIGELIA RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30345-3969
Country : US
Telephone Number : 404-213-3672
Fax Number : 404-633-4271
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/08/2007

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