DR. KEITH JACKSON


Address: 1360 Upper Hembree Rd Ste 201b, Roswell, GA 30076-1230
Phone: 7704753361

DR. KEITH JACKSON (NPI# 1225016454) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1225016454
Entity Type Individual
Full Name DR. KEITH JACKSON
Credential MD
Practice Address 1360 Upper Hembree Rd Ste 201b
Roswell
GA 30076-1230
Mailing Address 12080 Wildwood Springs Dr
Roswell
GA 30075-1887
Practice Telephone 7704753361
Mailing Telephone 7704753361
Mailing Fax Number 7706644431
Enumeration Date 2006-01-06
Last Update Date 2019-10-15
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207Y00000X Otolaryngology 027575 GA Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
GA 00377539B 05
GA 00377539C 05

Provider Secondary Practice Location

Address Telephone Number Fax Number
11685 Alpharetta Hwy, Suite 300, Roswell, GA 300764913 7704753361 7706644431

Other Providers KEITH JACKSON

NPI Name Taxonomy Address Enumeration
1407491673 Keith Jackson Home Health 2934 Pelzer Ave, Montgomery, AL 36109-2147 2019-11-12
1871935569 Keith Daniel Jackson Dentist 10868 Us Highway 15 501, Southern Pines, NC 28387-5149 2013-07-23
1720263031 Keith Edward Jackson Nurse Practitioner 11114 Endicott Ln, Houston, TX 77035-3007 2008-01-04
1205866142 Keith E Jackson Nurse Anesthetist, Certified Registered 100 Rice Mine Rd N, Tuscaloosa, AL 35406-2300 2006-07-04
1184278129 Keith T. Jackson Physical Therapist 4000 Johnson Rd, Steubenville, OH 43952-2364 2019-07-29
1326527045 Keith Allen Jackson Physician Assistant 3000 Q St Fl 4, Sacramento, CA 95816-7058 2018-08-13
1457837551 Keith Jackson Case Manager/Care Coordinator 1430 Olive St Ste 400, Saint Louis, MO 63103-2303 2018-07-12
1952890030 Keith Wesley Jackson Pharmacist 1900 Carew St Ste 4, Fort Wayne, IN 46805-4765 2018-05-04
1033557228 Keith L Jackson Rehabilitation Practitioner 7381 Prairie Falcon Rd, Las Vegas, NV 89128-0811 2013-06-10
1033461280 Keith Darnell Jackson Social Worker 7550 Constantinople Ave, Las Vegas, NV 89129-6505 2012-10-12

Office Location

Street Address 1360 UPPER HEMBREE RD STE 201B
City ROSWELL
State GA
Zip Code 30076-1230

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1689275505 Apex Spine and Neurosurgery LLC Neurological Surgery 1295 Hembree Rd Ste 200 Bldg B, Roswell, GA 30076 2020-11-06
1841776689 Scott Gunter Brunson Hearing Instrument Specialist 777 Old Roswell Pl # E100, Roswell, GA 30076 2018-07-16
1861998197 Daniel B Charek Clinical Neuropsychologist 11685 Alpharetta Hwy Ste 170, Roswell, GA 30076 2018-04-04
1427575554 A One Home Care, Inc. In Home Supportive Care 1875 Old Alabama Road, Suite 420, Roswell, GA 30076 2017-08-29
1053836023 Madelon Morgan Counselor 555 Sun Valley Dr Bldg F, Roswell, GA 30076 2017-08-10
1245769637 Family Behavioral Health, LLC Clinic/Center 9275 Martin Rd, Roswell, GA 30076 2017-06-08
1093163750 Ryann Soutar Counselor 702 Macy Dr, Roswell, GA 30076 2016-06-02
1447618707 Concierge Medical Mgmt Group Contractor 760 Old Roswell Rd Ste 117, Roswell, GA 30076 2016-02-02
1063877710 Augustine Young Community/Behavioral Health 427 Royal Creek Dr, Roswell, GA 30076 2015-12-23
1710360441 Currents Massage LLC Massage Therapist 760 Old Roswell Road, Suite 230, Roswell, GA 30076 2015-06-30
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Taxonomy Information

Taxonomy Code 207Y00000X
Grouping Allopathic & Osteopathic Physicians
Classification Otolaryngology

Taxonomy Definition

An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source]
- Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1902908015 Peter Bailey Md Pa Otolaryngology 313 W Country Club Road, Roswell, NM 88201 2006-09-01
1225090046 Jan Delos Hobbs Otolaryngology 601 W Country Club Rd Ste 202, Roswell, NM 88201 2006-04-05
1447798715 North Fulton Hearing Center LLC Otolaryngology 2500 Hospital Blvd, Suite 450, Roswell, GA 30076-4907 2017-02-07
1215255203 Sunny Singh Khichi Otolaryngology 2500 Hospital Boulevard, Suite 450, Roswell, GA 30076-4919 2010-05-14
1093736613 Vivek V. Gurudutt Otolaryngology 1360 Upper Hembree Rd, Suite 201b, Roswell, GA 30076-1171 2006-07-21
1477593168 Peter Bailey Otolaryngology 313 W Country Club Rd, Suite 2, Roswell, NM 88201-5804 2006-06-08
1114905379 Andrew Diamond Otolaryngology 1360 Upper Hembree Rd, Suite 201, Roswell, GA 30076-1171 2006-01-06

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1801402714 Top Dog Solutions LLC Otolaryngology 4295 Interstate Dr Ste B, Macon, GA 31210-6815 2020-09-17
1164076600 Oglethorpe Ear, Nose & Throat, LLC Otolaryngology 219 West Boggs Street, Lexington, GA 30648 2019-08-01
1154822971 Coastal Ear, Nose & Throat Otolaryngology 200 Blue Moon Xing Ste 103, Pooler, GA 31322-9698 2018-02-27
1376928069 Wiley A. Parker M.d PC Otolaryngology 5669 Peachtree Dunwoody Ste 295, Atlanta, GA 30342-1719 2015-07-23
1871970210 North Atlanta Ear Nose & Throat PC Otolaryngology 4150 Deputy Bill Cantrell Memorial Dr., Suite 260, Cumming, GA 30040 2015-05-06
1235516741 Alicia Bernstein Otolaryngology 3400c Old Milton Pkwy Ste 365, Alpharetta, GA 30005-4438 2015-05-04
1730576638 Mark Arnold Otolaryngology 550 Peachtree St Ne Ste 1135550, Atlanta, GA 30308-2247 2015-04-20
1851789580 William Lawrence Nicholson Otolaryngology 360 W 37th St, Sea Island, GA 31561-9748 2015-01-05
1528473881 Nnenna Ezeilo Otolaryngology 619 S 8th St Ste 304, Griffin, GA 30224 2014-06-25
1922413343 Colin Wyatt Fuller Otolaryngology 1120 Fifteenth St, Bp-4109, Augusta, GA 30912 2014-06-24
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Competitor

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City ROSWELL
Zip Code 30076

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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