MEDICARE: ENCOMPASS HEALTHCARE, PC

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
1	207R00000X	Internal Medicine Physician	051007	GA

General Provider Information

NPI Number	:	1881905594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENCOMPASS HEALTHCARE, PC

Provider Business Mailing Address
First Line	:	3006 DOGWOOD DR
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-3906
Country	:	US
Telephone Number	:	404-784-0607
Fax Number	:

Provider Business Practice Location Address
First Line	:	3006 DOGWOOD DR
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-3906
Country	:	US
Telephone Number	:	404-784-0607
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. REGINALD ROBERTS JACKSON
Credential	:	M.D.
Telephone Number	:	404-784-0607

Provider Enumeration Date	:	06/28/2010
Last Update Date	:	06/28/2010

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