Organization
GERALDINE JACKSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALDINE JACKSON (PRESIDENT)
(770) 947-3967
Entity
Organization
Contact information
Practice address
149 N PARK TRL, STOCKBRIDGE, GA 30281-7373
(770) 947-3967
(678) 369-7392
Mailing address
149 N PARK TRL, STOCKBRIDGE, GA 30281-7373
(770) 947-3967
(678) 369-7392
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
GA
Other
Enumeration date
09/25/2006
Last updated
07/21/2022
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