| Doctor Name: | DR. EMILY BROCKETT JACKSON |
| NPI Number: | 1003126962 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD |
| License Number: | PSY003380 |
| Business Practice Address: | 1670 Clairmont Road Atlanta Va Medical Center Decatur, GA - 30033 |
| Business Phone Number: | 4044290419 |
| Business Fax Number: | |
| Mailing Address: | 15 Cardinal Ct, STOCKBRIDGE |
| State: | GA |
| Postal Code: | 302811785 |
| Phone Number: | 4044290419 |
| Fax Number: | |
| NPI Enumeration Date: | 10/13/2010 |
| NPI Last Update Date: | 10/13/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC1900X |
| License Number: | PSY003380 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Counseling |
| Taxonomy Definition: | |