Individual
MRS. KIMBERLY STEWART JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
247 LANA DR, GRAY, GA 31032-5883
(478) 986-0484
(478) 986-0486
Mailing address
PO BOX 1726, GRAY, GA 31032-1726
(478) 986-0484
(478) 986-0486
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT001628
GA
Other
Enumeration date
03/31/2008
Last updated
03/31/2008
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