Individual
MRS. REBECCA DOTT JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
755 WALTHER RD, LAWRENCEVILLE, GA 30046-8725
(404) 252-7618
(678) 843-5525
Mailing address
1416 BUBBLING CREEK RD NE, ATLANTA, GA 30319-2104
(404) 333-2911
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5467
GA
Other
Enumeration date
11/01/2009
Last updated
11/01/2009
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