Individual
DENISE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11720 MEDLOCK BRIDGE RD STE 155, JOHNS CREEK, GA 30097
(574) 320-3549
Mailing address
11720 MEDLOCK BRIDGE RD STE 155, JOHNS CREEK, GA 30097-1513
(574) 320-3549
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
BC29700281
IN
224P00000X
Prosthetist
Primary
CO124581
GA
Other
Enumeration date
06/21/2018
Last updated
06/27/2018
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