Provider Demographics
NPI:1245282037
Name:ROSS JR, WILLIAM A J ALEXANDER JACKSON JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM A J
Middle Name:ALEXANDER JACKSON
Last Name:ROSS JR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 NISKEY LAKE TRL SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-6326
Mailing Address - Country:US
Mailing Address - Phone:404-344-9755
Mailing Address - Fax:
Practice Address - Street 1:33 UPPER RIVERDALE RD SW STE 112
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2642
Practice Address - Country:US
Practice Address - Phone:770-897-7874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY52433207X00000X
GA047650207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00839462EMedicaid
KY52433OtherKY MEDICAL LICENSE
GA00839462EMedicaid
GA20BBFQWMedicare ID - Type Unspecified