MEDICARE: MR. ROBERT WALLACE JACKSON JR.

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	253Z00000X	In Home Supportive Care Agency	PHCP010932	GA

General Provider Information

NPI Number	:	1932791993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT WALLACE JACKSON JR.

Provider Business Mailing Address
First Line	:	1355 TERRELL MILL RD SE BLDG 1462-125
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-5559
Country	:	US
Telephone Number	:	470-632-7400
Fax Number	:	470-524-0500

Provider Business Practice Location Address
First Line	:	1355 TERRELL MILL RD SE BLDG 1462-125
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-5559
Country	:	US
Telephone Number	:	470-632-7400
Fax Number	:	470-524-0500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2021
Last Update Date	:	02/10/2021

Similar Medicare Providers

1467383984 — KATHERINE GARCIA LMSW
Practice Location Address:

1640 POWERS FERRY RD SE STE 100
MARIETTA, GA
30067-5491

Practice Phone: 404-660-7676
Practice Fax:

1932031630 — ASPIRE WELLNESS OF EAST COBB LLC
Practice Location Address:

1640 POWERS FERRY RD BUILDING 21 SUITE 200
MARIETTA, GA
30067

Practice Phone: 678-540-4757
Practice Fax:

1841127651 — KRYSTIONA MCLEAN
Practice Location Address:

1640 POWERS FERRY RD SE STE 100
MARIETTA, GA
30067-5491

Practice Phone: 404-660-7676
Practice Fax:

1689234106 — MARCKENLEY ISAAC MD
Practice Location Address:

2540 WINDY HILL RD SE
MARIETTA, GA
30067-8605

Practice Phone: 470-644-1274
Practice Fax:

1770770794 — DR. KEITH T WILLIAMS DDS
Practice Location Address:

2900 DELK RD SE STE 420
MARIETTA, GA
30067-5320

Practice Phone: 248-943-4817
Practice Fax:

1083544886 — BRIANA NIXON
Practice Location Address:

877 FRANKLIN GTWY SE STE 280
MARIETTA, GA
30067-8037

Practice Phone: 470-523-2307
Practice Fax:

Directions to “ MR. ROBERT WALLACE JACKSON JR. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.