Individual
DEALLEN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2131 STALLINGS ST NW # 2832, COVINGTON, GA 30014-2351
(770) 895-2978
(678) 550-9431
Mailing address
2131 STALLINGS ST NW # 2832, COVINGTON, GA 30014-2351
(770) 895-2978
(678) 550-9431
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/11/2024
Last updated
03/11/2024
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