Individual
MR. VINCENT PAUL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RT(R)
Contact information
Practice address
4950 GLAZE DR, ATLANTA, GA 30360-1702
(770) 990-6821
Mailing address
4950 GLAZE DR, ATLANTA, GA 30360-1702
(770) 990-6821
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
394412
MN
Other
Enumeration date
06/11/2012
Last updated
06/11/2012
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