Individual
PURDY JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
705 DIXIE ST, CARROLLTON, GA 30117-3818
(770) 812-9666
Mailing address
705 DIXIE ST, CARROLLTON, GA 30117-3818
(770) 812-9666
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86113132
GA
Other
Enumeration date
05/20/2020
Last updated
05/20/2020
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