Provider Demographics
NPI:1003490137
Name:JACKSON, EMILY MAE (DPT, OCS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MAE
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:MAE
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:11840 DANCLIFF TRCE
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-8736
Mailing Address - Country:US
Mailing Address - Phone:404-483-7597
Mailing Address - Fax:
Practice Address - Street 1:87 VICKERY ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4924
Practice Address - Country:US
Practice Address - Phone:404-254-5607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist