Individual
TAWANNA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CERTIFIED PEER RECOV
Contact information
Practice address
3370 FLAT SHOALS RD, COLLEGE PARK, GA 30349-4008
(678) 558-9330
Mailing address
3370 FLAT SHOALS RD, COLLEGE PARK, GA 30349-4008
(678) 558-9330
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000
—
GA
Enumeration date
03/15/2021
Last updated
03/15/2021
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