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NPI Code Detail

MEDICARE: DR. CARLOTTA MARIE JACKSON

MEDICARE: DR. CARLOTTA MARIE JACKSON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1922966753
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARLOTTA MARIE JACKSON
Provider Business Mailing Address
First Line : 7500 SAN FELIPE ST STE 990
Second Line :
City : HOUSTON
State : TX
Zip : 77063-1708
Country : US
Telephone Number : 866-610-0580
Fax Number : 866-611-1558
Provider Business Practice Location Address
First Line : 4920 ROSWELL RD STE 1
Second Line :
City : ATLANTA
State : GA
Zip : 30342-2684
Country : US
Telephone Number : 470-258-4050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2026
Last Update Date : 01/12/2026

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