Individual
FELTON LEWIS JACKSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4190 MISTYMORN WAY, POWDER SPRINGS, GA 30127-2591
(678) 557-5770
(770) 800-8127
Mailing address
251 KYLES CIR, HIRAM, GA 30141-4695
(678) 557-5770
(770) 800-8127
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
060541970
GA
Other
Enumeration date
11/12/2020
Last updated
10/31/2024
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