Individual
MS. TANISHA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1271 HOGANSVILLE RD APT 115, LAGRANGE, GA 30241-6667
(334) 646-1574
Mailing address
1271 HOGANSVILLE RD APT 115, LAGRANGE, GA 30241-6667
(334) 646-1574
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/04/2019
Last updated
02/04/2019
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