Individual
MRS. DIONTAE SHERREE' JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPT
Contact information
Practice address
118 WHITLEY XING, ROCKMART, GA 30153-1101
(828) 817-9111
Mailing address
118 WHITLEY XING, ROCKMART, GA 30153-1101
(828) 817-9111
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
D7D5R5F7
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G8RWUDZX5PS5
UEI
GA
Enumeration date
06/06/2024
Last updated
06/06/2024
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