NPI 1225016454

Keith Jackson, MD

Practitioner Otolaryngology Physician Roswell, GA

Practice location

Address: 1360 Upper Hembree Rd STE 201b, Roswell, GA 30076-1230
Phone: (770) 475-3361
Mailing address: 12080 Wildwood Springs Dr, Roswell, GA 30075-1887

Registered specialties

Otolaryngology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207Y00000X Licence 027575 (GA)

Other Otolaryngology providers in Georgia →

Registry record

NPI: 1225016454
Entity type: Individual
Sex (as registered): Male
NPI issued: 6 Jan 2006
Record last updated: 15 Oct 2019

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.