Individual
GEORGIA S JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED, CCC-SLP
Contact information
Practice address
1488 OLD OCILLA RD, TIFTON, GA 31794-4152
(229) 386-5200
Mailing address
1488 OLD OCILLA RD, TIFTON, GA 31794-4152
(229) 386-5200
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP003934
GA
Other
Enumeration date
05/25/2012
Last updated
05/25/2012
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