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5370 Campbellton Fairburn Rd, 410, Fairburn, GA 30213-2296 | |
(972) 689-6722 | |
Not Available |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 5370 Campbellton Fairburn Rd, Fairburn, Georgia |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1235534207 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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152W00000X | Optometrist | OPT002717 (Georgia) | Primary |
Provider Name | Danielle N Jackson |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1043568413 PECOS PAC ID: 9537318514 Enrollment ID: I20121008000264 |
Mailing Address | Practice Location Address |
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5370 Campbellton Fairburn Rd, 410, Fairburn, GA 30213-2296 Ph: (972) 689-6722 | 5370 Campbellton Fairburn Rd, 410, Fairburn, GA 30213-2296 Ph: (972) 689-6722 |