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Individual

DANIELLE JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
240 E BELLE ISLE RD APT 339, ATLANTA, GA 30342-2399
(678) 640-2104
Mailing address
240 E BELLE ISLE RD APT 339, ATLANTA, GA 30342-2399

Taxonomy

Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
33582
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0000
NOT REQUIRED TO OBTAIN THEM
GA
Enumeration date
11/12/2020
Last updated
11/12/2020
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Product
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