Individual
ATAVIA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ST
Contact information
Practice address
5229 JACKSON RD, MORVEN, GA 31638-3934
(229) 561-5507
Mailing address
5229 JACKSON RD, MORVEN, GA 31638-3934
(229) 561-5507
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
05/30/2018
Last updated
05/30/2018
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