RICHARD THOMAS JACKSON (Credential# 1675466) is licensed (Physician/surgeon) with Connecticut Department of Consumer Protection. The license effective date is November 1, 2019. The license expiration date date is November 30, 2020. The license status is ACTIVE.
RICHARD THOMAS JACKSON is licensed with the Department of Consumer Protection of Connecticut. The credential number is #1.064522. The credential type is physician/surgeon. The effective date is November 1, 2019. The expiration date is November 30, 2020. The business address is 5220 Jimmy Lee Smith Pkwy, Hiram, GA 30141. The current status is active.
Licensee Name | RICHARD THOMAS JACKSON |
Credential ID | 1675466 |
Credential Number | 1.064522 |
Credential Type | Physician/Surgeon |
Business Address |
5220 Jimmy Lee Smith Pkwy Hiram GA 30141 |
Business Type | INDIVIDUAL |
Status | ACTIVE - CURRENT |
Active | 1 |
Issue Date | 2019-11-01 |
Effective Date | 2019-11-01 |
Expiration Date | 2020-11-30 |
Refresh Date | 2019-11-04 |
Street Address | 5220 Jimmy Lee Smith Pkwy |
City | Hiram |
State | GA |
Zip Code | 30141 |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Roy Armand Poblete | 5220 Jimmy Lee Smith Pkwy, Hiram, GA 30141 | Physician/surgeon | 2020-07-01 ~ 2021-06-30 |
Preet Martand Varade | 5220 Jimmy Lee Smith Pkwy, Hiram, GA 30141 | Physician/surgeon | 2020-05-01 ~ 2021-04-30 |
Michael Katsnelson | 5220 Jimmy Lee Smith Pkwy, Hiram, GA 30141 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
Sebina Bulic | 5220 Jimmy Lee Smith Pkwy, Hiram, GA 30141 | Physician/surgeon | 2020-02-01 ~ 2021-01-31 |
Alexander Zubkov | 5220 Jimmy Lee Smith Pkwy, Hiram, GA 30141 | Physician/surgeon | 2019-11-01 ~ 2020-10-31 |
Nirav Himanshu Shah | 5220 Jimmy Lee Smith Pkwy, Hiram, GA 30141 | Physician/surgeon | 2019-09-03 ~ 2020-09-30 |
Amirhossein Zangiabadi | 5220 Jimmy Lee Smith Pkwy, Hiram, GA 30141 | Physician/surgeon | 2019-10-01 ~ 2020-09-30 |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Lilian Moragwa Nyareru | 114 High Point Way, Hiram, GA 30141 | Registered Nurse | 2020-07-01 ~ 2021-06-30 |
Mark N Rubin | 5220 Jimmy Lee Smith Parkway, Hiram, GA 30141 | Physician/surgeon | 2019-10-11 ~ 2020-10-31 |
Rolanda Jefferson | 79 Kennedy Ct, Hiram, GA 30141 | Registered Nurse - Temporary | 2017-06-28 ~ 2017-10-25 |
Yolanda J Dillon | 5220 Jimmy Lee Smith Pkwy Suite#104-249, Hiram, GA 30141 | Real Estate Broker | 2012-04-01 ~ 2013-03-31 |
Patricia M Brooks · Mayer | 5102 Heritage Oaks Ln Sw, Hiram, GA 30141 | Licensed Practical Nurse | 2011-07-01 ~ 2012-06-30 |
Sarah A Atha | 94 Wisteria Drive, Hiram, GA 30141 | Registered Nurse | 2009-05-28 ~ 2010-07-31 |
David J Craven | 160 Pooles Bend Ct, Hiram, GA 30141 | Electrical Unlimited Journeyperson | 1996-10-01 ~ 1997-09-30 |
Bryan J Moore | 5220 Jimmy Lee Smith Parkway, Hiram, GA 30141 | Physician/surgeon | 2019-09-23 ~ 2020-07-31 |
Tamira Outlaw | 373 Greystone Pkwy, Hiram, GA 30141-3162 | Registered Nurse | 2014-06-02 ~ 2015-06-30 |
Susanne N Miller | 110 Trailside Way, Hiram, GA 30141-3271 | Registered Nurse - Temporary | 2014-04-17 ~ 2014-08-14 |
Find all Licenses in zip 30141 |
City | Hiram |
Zip Code | 30141 |
License Type | Physician/Surgeon |
License Type + County | Physician/Surgeon + Hiram |
Licensee Name | Office Address | Credential | Effective / Expiration |
---|---|---|---|
Richard C Miller | 2229 Greenbriar Drive, Jackson, MS 39211 | Physician/surgeon | 2008-09-12 ~ 2009-11-30 |
Richard Thomas Md | 3 Marshepaug Rd, Goshen, CT 06756-2115 | Physician/surgeon | 2010-09-01 ~ 2011-08-31 |
Richard Thomas Kim Md | 14 Rye Ridge Plaza, Rye Brook, NY 10573 | Physician/surgeon | 2001-10-01 ~ 2002-10-31 |
Melecio G Abordo Jr | Po Box 974, Jackson, KY 41339 | Physician/surgeon | 2001-07-30 ~ 2002-07-31 |
William M Griffin | Po Box 877, Jackson, CA 95642 | Physician/surgeon | 1999-04-13 ~ 2000-04-30 |
Max G Jackson Jr | 77 Pringle Way, Reno, NV 89502 | Physician/surgeon | 1977-02-07 ~ 1984-06-30 |
Jeffrey T Tyler | 196 Jackson Ave, Stratford, CT 06497 | Physician/surgeon | 1981-11-02 ~ 1989-02-28 |
James D. Bentley | 46 Jackson Dr, Cranford, NJ 07016-3504 | Physician/surgeon | 2020-03-01 ~ 2021-02-28 |
Carine R Klein | P.o.box 10100, Jackson, WY 83002 | Physician/surgeon | 2016-04-01 ~ 2017-03-31 |
Benjamin D Mason | 122 Jackson St Apt 1a, Hoboken, NJ 07030-6084 | Physician/surgeon | 2020-04-01 ~ 2021-03-31 |
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Data Provider | Connecticut Department of Consumer Protection |
Jurisdiction | Connecticut |
Related Datasets | Connecticut Business Registrations, Connecticut Child Care Facilities |
This dataset includes 1.41 million licenses issued wtih Connecticut Department of Consumer Protection (TDLR).