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Individual

JEREMY JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
2185 NORMANDIE DR, MONTGOMERY, AL 36111-2728
(334) 202-4638
Mailing address
50 PLAZA WAY NW, MARIETTA, GA 30060-1141
(786) 912-2066
(404) 393-3133

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
19-97334
AL
106S00000X
Behavior Technician
Primary
RBT-19-97334

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
RBT-19-97334
RBT
GA
01
RBT-19-97334
RBT
Enumeration date
08/28/2019
Last updated
07/09/2020
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