MARLON B JACKSON (NPI# 1558423491) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558423491 |
| Entity Type | Individual |
| Full Name | MARLON B JACKSON |
| Credential | D.D.S |
| Practice Address |
1046 Ridge Ave Sw Suite 1 Atlanta GA 30315-1640 |
| Mailing Address |
210 Auburn Ave Ne Suite 1 Atlanta GA 30303-2610 |
| Practice Telephone | 4046813834 |
| Practice Fax Number | 4046819108 |
| Mailing Telephone | 4046813834 |
| Mailing Fax Number | 4046819108 |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2013-02-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
9878 | GA | Dental Providers |
| Street Address |
1046 RIDGE AVE SW SUITE 1 |
| City | ATLANTA |
| State | GA |
| Zip Code | 30315-1640 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235123993 | Southside Medical Center, Inc. | Clinic/Center | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2005-09-08 |
| 1902427669 | Jacqueline Hamilton | Dietitian, Registered | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2020-05-04 |
| 1588290670 | Rutubula Pettaway | Social Worker | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2020-03-20 |
| 1063975944 | Donnamarie Wilson | Registered Nurse | 1046 Ridge Ave Sw, Atlanta, GA 30315 | 2019-04-09 |
| 1225598030 | Joi Raines | Nurse Practitioner | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2019-03-20 |
| 1417432006 | Taylor Breann Gonzalez | Advanced Practice Midwife | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2018-09-28 |
| 1154810299 | Keli Chapman | Midwife | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2018-05-03 |
| 1730680992 | Dena Boykin | Dental Hygienist | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2018-02-23 |
| 1063913234 | Sadaf Rehmani | Dental Hygienist | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2018-02-23 |
| 1629519251 | Anita Khimani | Clinic/Center | 1046 Ridge Ave Sw, Atlanta, GA 30315-1640 | 2017-03-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083181341 | Erin Cole | Specialist/Technologist | Lakewood Ave Se, Atlanta, GA 30315 | 2018-10-25 |
| 1942701081 | Julie Crocker | Dental Hygienist | 1046 Ridge Ave. Sw, Atlanta, GA 30315 | 2018-02-23 |
| 1457695850 | Dominica Aquino Morales-gibson | Physical Therapist | 2850 Springdale Road Sw, Atlanta, GA 30315 | 2012-11-26 |
| 1912264813 | Maxwell Uhakheme | Internal Medicine | 6875 Douglas Blvd, Suite A, Kaiser Permanente Douglasville Medical Center, Douglasville, GA 30315 | 2012-04-16 |
| 1427329093 | Sulonda Smith | Counselor | 34 Atlanta Ave. Se, Hank Aaron Blvd, Atlanta, GA 30315 | 2012-01-13 |
| 1407152507 | Gerald Leroy Griffin | Pharmacist | 520 Boulevard, Atlanta, GA 30315 | 2011-02-07 |
| 1245404854 | Tunisia Finch Cornelius | Dermatology | 1039 Grant St Se Ste A-11, Atlanta, GA 30315 | 2008-04-15 |
| 1356512180 | Chandra Blakely | Counselor | 215 Lakewood Way, Suite 205, Atlanta, GA 30315 | 2008-03-19 |
| 1104043967 | Alvin H. Clair, M.d.p.c. | Dermatology | 777 Cleveland Ave.,sw Ste.500, Atlanta, GA 30315 | 2007-04-20 |
| 1396877742 | Scott M Russell | Speech-Language Pathologist | 1364 Clifton Road, Atlanta, GA 30315 | 2007-03-12 |
| Find all providers in zip 30315 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568079143 | Bimala Gharti | Dentist | 7310 Village Creek Trce, Atlanta, GA 30328-6763 | 2020-09-28 |
| 1699385062 | Hetal Trivedi | Dentist | 930 Spring St Nw Unit 915-a, Atlanta, GA 30309-3816 | 2020-07-31 |
| 1013548577 | Dental Care 24 7 Staffing Atlanta, LLC | Dentist | 285 Centennial Olympic Park Dr Nw # Cu-2b, Atlanta, GA 30313-1834 | 2020-02-03 |
| 1013547173 | Sha-vashtiy Young-ufeli | Dentist | 587 Virginia Ave Ne Unit 5, Atlanta, GA 30306-3695 | 2020-01-16 |
| 1588210207 | Edgewood Smiles Dentistry, PC | Dentist | 144 Moreland Ave Ne Ste A, Atlanta, GA 30307-2660 | 2019-08-19 |
| 1912552464 | Casey Jean Shuster | Dentist | 999 Peachtree St Ne Ste 715, Atlanta, GA 30309-3964 | 2019-08-01 |
| 1306404389 | Gabrielle Coe | Dentist | 205 S Race St, Atlanta, IL 61723-7586 | 2019-06-04 |
| 1417513730 | Jordan Alexander Reznik | Dentist | 236 Perimeter Center Pkwy Ne Ste C-30, Atlanta, GA 30346-1402 | 2019-05-13 |
| 1316419666 | Vbdc of Woodstock, LLC | Dentist | 5909 Peachtree Dunwoody Rd Ste 800, Atlanta, GA 30328-8103 | 2018-12-27 |
| 1487136867 | Abby Lynn Halpern | Dentist | 1080 Peachtree St Ne Unit 2604, Atlanta, GA 30309-6836 | 2018-09-03 |
| Find all providers in ATLANTA | ||||
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| 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.