Individual
MISS KEILON LATRICE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMA
Contact information
Practice address
511 DOWNING ST, LAWRENCEVILLE, GA 30045-4597
(678) 577-9097
Mailing address
511 DOWNING ST, LAWRENCEVILLE, GA 30045-4597
(678) 577-9097
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
20019336068
GA
374U00000X
Home Health Aide
Primary
20019336068
GA
376K00000X
Nurse's Aide
20019336068
GA
Other
Enumeration date
04/23/2007
Last updated
01/05/2012
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