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Individual

MRS. AMANDA Z. JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.T.

Contact information

Practice address
575 DEKALB INDUSTRIAL WAY, SUITE 103, DECATUR, GA 30030-1756
(404) 296-8511
(404) 296-8514
Mailing address
2650 WEIGELIA RD NE, ATLANTA, GA 30345-3969
(404) 633-9955
(404) 633-4271

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
002496
GA

Other

Enumeration date
12/01/2006
Last updated
07/08/2007
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