Individual
KIMBERLY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
277 HIGHWAY 74 N, STE 203, PEACHTREE CITY, GA 30269-1569
(678) 364-0337
(678) 364-0858
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT001774
GA
Other
Enumeration date
05/31/2012
Last updated
05/31/2012
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