Individual
DANYIELLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT-NCTM
Contact information
Practice address
323 SPRING CREEK WAY, DOUGLASVILLE, GA 30134-1688
(256) 759-8352
Mailing address
323 SPRING CREEK WAY, DOUGLASVILLE, GA 30134-1688
(256) 759-8352
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT005209
GA
Other
Enumeration date
08/21/2008
Last updated
10/24/2008
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