Trevis Shantell Jackson, is a
Physical Medicine & Rehabilitation physician based in Fairburn, Georgia. Trevis Shantell Jackson is licensed to practice in Georgia (license number OTA000749) and her current practice location is 7420 Mistydawn Dr, Fairburn, Georgia. She can be reached at her office (for appointments etc.) via phone at
(678) 361-8944.
NPI number for Trevis Shantell Jackson is 1073321659 and her current mailing address is 7420 Mistydawn Dr, Fairburn, Georgia. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1073321659.
Physician's Profile
| Full Name | Trevis Shantell Jackson |
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| Gender | Female |
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| Speciality | Physical Medicine & Rehabilitation |
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| Location | 7420 Mistydawn Dr, Fairburn, Georgia |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1073321659
- Provider Enumeration Date: 12/27/2024
- Last Update Date: 12/27/2024
Medical Identifiers
Medical identifiers for Trevis Shantell Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1073321659 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208100000X | Physical Medicine & Rehabilitation | OTA000749 (Georgia) | Primary |
| 224Z00000X | Occupational Therapy Assistant | OTA000749 (Georgia) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Trevis Shantell Jackson is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Trevis Shantell Jackson,
7420 Mistydawn Dr,
Fairburn, GA 30213-4330
Ph: (678) 361-8944 | Trevis Shantell Jackson,
7420 Mistydawn Dr,
Fairburn, GA 30213-4330
Ph: (678) 361-8944 |
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