Individual
IDA DESIREE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
291 PLANTATION CENTRE DR N APT 705, MACON, GA 31210-9249
(478) 447-7052
Mailing address
291 PLANTATION CENTRE DR N APT 705, MACON, GA 31210-9249
(478) 447-7052
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002042
GA
Other
Enumeration date
09/21/2023
Last updated
09/21/2023
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