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Individual
WILLIAM THOMAS JACKSON
Active
Individual
WILLIAM THOMAS JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., ATC
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AT002062
GA
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/09/2014
Last updated
02/05/2021
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