Individual
LISA MICHELLE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PP, BS
Contact information
Practice address
6200 BRADLEY PARK DR, COLUMBUS, GA 31904-3078
(706) 604-7640
Mailing address
6200 BRADLEY PARK DR, COLUMBUS, GA 31904-3078
(706) 604-7640
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/06/2019
Last updated
11/06/2019
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