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Individual

ANNE MARIE JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
3200 SHAKERAG HL, PEACHTREE CITY, GA 30269-6511
(770) 487-0760
Mailing address
264 CLARIDGE CURV, PEACHTREE CITY, GA 30269-2627
(678) 545-0951

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT004476
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PT004476
STATE LISC NUMBER
GA
Enumeration date
11/03/2006
Last updated
07/08/2007
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