Individual
BREIANE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICENSED CPHT
Contact information
Practice address
2790 COBB PKWY NW, KENNESAW, GA 30152-3455
(770) 793-1838
Mailing address
4624 UNICORN PT, POWDER SPRINGS, GA 30127-5374
(770) 361-1315
Taxonomy
Speciality
Code
Description
License number
State
183700000X
Pharmacy Technician
Primary
PHTC051863
GA
Other
Enumeration date
10/22/2020
Last updated
10/22/2020
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