Individual
MRS. MONIQUE LASEAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
2910 BUFORD DR, APT# 702, BUFORD, GA 30519-5109
(678) 523-1627
(678) 765-0300
Mailing address
2910 BUFORD DR, APT# 702, BUFORD, GA 30519-5109
(678) 523-1627
(678) 765-0300
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/16/2012
Last updated
05/16/2012
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