Individual
CHEVIS M JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
125 SAMARITAN DR, CUMMING, GA 30040-2354
(770) 889-1644
Mailing address
1335 OAKSHYRE PL, LAWRENCEVILLE, GA 30043-6435
(504) 912-5169
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA003382
GA
Other
Enumeration date
03/24/2021
Last updated
03/24/2021
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