Individual
DARRYL MAURICE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
328 MCCOOK CIR NW, KENNESAW, GA 30144-3156
(904) 501-5304
(678) 653-7865
Mailing address
328 MCCOOK CIR NW, KENNESAW, GA 30144-3156
(904) 501-5304
(678) 653-7865
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/14/2019
Last updated
06/14/2019
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