Angela Patrice Jackson, M.D.

Pediatrics Physician · Riverdale, GA

Individual Active NPI

NPI number 1124292826

Practice location

808 Commerce Blvd
Suite a
Riverdale, GA 30296-7192
Phone
(770) 996-9191
Fax
(770) 996-5298

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NPI record

NPI
1124292826
Entity type
Individual (Type 1)
Enumeration date
April 15, 2008
Last updated
October 25, 2011
Sole proprietor
Yes

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Pediatrics Physician Primary 208000000X 001627 GA

About Dr. Jackson

Angela Patrice Jackson, M.D. is a healthcare provider registered in the NPI registry with the primary taxonomy Pediatrics Physician (code 208000000X). The practice location is 808 Commerce Blvd, Suite a, Riverdale, GA 30296-7192. The NPI number 1124292826 was assigned on April 15, 2008 and the record was last updated on October 25, 2011.

Dr. Jackson lists a license in the registry: #001627 (GA) for Pediatrics Physician. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Angela Patrice Jackson, M.D.?

The NPI number is 1124292826.

What is the phone number of Dr. Jackson?

The phone number listed for the practice location is (770) 996-9191.

Where is Dr. Jackson located?

808 Commerce Blvd, Suite a, Riverdale, GA 30296-7192.

What is the taxonomy code for Dr. Jackson?

The primary taxonomy code is 208000000X – Pediatrics Physician.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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