Individual
OLYMPHIA ANECIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSPT
Contact information
Practice address
4352 MISSOULA PL, DOUGLASVILLE, GA 30135-8608
(678) 715-1544
Mailing address
PO BOX 6867, DOUGLASVILLE, GA 30154-0032
(678) 715-1544
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
PT007580
GA
Other
Enumeration date
10/04/2006
Last updated
07/09/2007
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