Individual
BRANDON TRAVON JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1395 S MARIETTA PKWY SE STE 212, MARIETTA, GA 30067-7832
(770) 615-7900
Mailing address
3360 OHARA DR N, MACON, GA 31206-3832
(478) 216-8765
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT015749
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
NC
Other
Enumeration date
09/26/2016
Last updated
10/15/2024
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