Individual
COLLETTE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3458 MANSFIELD LN, SNELLVILLE, GA 30039-4673
(678) 886-4163
Mailing address
3458 MANSFIELD LN, SNELLVILLE, GA 30039-4673
(678) 886-4163
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT008846
GA
Other
Enumeration date
08/29/2016
Last updated
08/29/2016
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