Individual
MR. ANTWAIN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1711 10TH AVE SE, DECATUR, AL 35601-4915
(256) 226-0150
Mailing address
1711 10TH AVE SE, DECATUR, AL 35601-4915
(256) 226-0150
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
—
—
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
05/05/2021
Last updated
05/05/2021
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