Individual
MY LIEN THI JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
95 COLLIER RD NW, ATLANTA, GA 30309-1796
(404) 695-2781
Mailing address
268 SWEET CANE TRL, GRAYSON, GA 30017-4144
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
214895
GA
Other
Enumeration date
11/13/2025
Last updated
11/13/2025
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