Organization
NSP1RE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATORIA JACKAON (CEO)
(678) 671-0078
Entity
Organization
Contact information
Practice address
5317 PEACHTREE BLVD, GUARDIAN BUSINESS CENTER S306, CHAMBLEE, GA 30341
(678) 671-0078
(888) 948-2083
Mailing address
5317 PEACHTREE BLVD, S306, CHAMBLEE, GA 30341
(678) 671-0078
(888) 948-2083
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
05/15/2023
Last updated
05/15/2023
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