Individual
LATOYA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
193 MINNESOTA RD, DOERUN, GA 31744-5011
(229) 921-9476
Mailing address
193 MINNESOTA RD, DOERUN, GA 31744-5011
(229) 921-9476
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
09/15/2021
Last updated
09/15/2021
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