Individual
THERESA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 COMER AVE, COLUMBUS, GA 31904-8725
(706) 596-5764
(706) 596-5770
Mailing address
191 WAVERLY HALL RD, BOX SPRINGS, GA 31801-7527
(706) 269-3484
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
01/03/2008
Last updated
01/03/2008
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