Individual
MAXINE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HP
Contact information
Practice address
2100 COMER AVE, COLUMBUS, GA 31904-8725
(706) 660-9926
Mailing address
1548 MAZOR DR, COLUMBUS, GA 31907-4464
(706) 568-1539
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
05/21/2007
Last updated
07/08/2007
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