Individual
SHANQUEATA YATRICE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6501 MENLO WAY, REX, GA 30273-1624
(770) 557-9137
Mailing address
6501 MENLO WAY, REX, GA 30273-1624
(770) 557-9137
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
02/16/2026
Last updated
02/16/2026
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