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Individual

DANIELLE JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1845 SATELLITE BLVD NW, DULUTH, GA 30097-5256
(404) 778-5220
Mailing address
1845 SATELLITE BLVD NW, DULUTH, GA 30097-5256

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005295
GA

Other

Enumeration date
10/22/2010
Last updated
10/22/2010
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