Individual
JAMIE LYNN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6245 VANCE RD STE 109, CHATTANOOGA, TN 37421-4836
(303) 328-5869
Mailing address
310 HENRY LN, LOOKOUT MOUNTAIN, GA 30750-2710
(303) 328-5869
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
306
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171100000X
—
TN
01
—
306
ACUPUNCTURE LICENSE
TN
Enumeration date
09/05/2017
Last updated
09/05/2017
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