Individual
WILLIAM THOMAS JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., ATC
Contact information
Practice address
1364 CLIFTON RD NE, ATLANTA, GA 30322-1059
(404) 727-7825
Mailing address
PO BOX 362, HAMILTON, GA 31811-0362
(706) 325-8482
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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