Basic Information
| Provider Information | |||||||||
| NPI: | 1659665800 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JACOBSEN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | HERBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 235 PEACHTREE ST NE STE 2100 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303031405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709949326 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 235 PEACHTREE ST NE STE 2100 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303031405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709949326 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2011 | ||||||||
| LastUpdateDate: | 07/22/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | LL 33539 | SC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 72061 | GA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.