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Individual
OMAR DWAYNE JACK
Active
Individual
OMAR DWAYNE JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO, PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1109724
GA
363AM0700X
Medical Physician Assistant
MA062538
PA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/22/2013
Last updated
03/26/2024
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