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Individual

KIM JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1264 NEWMANTOWN RD, GROVETOWN, GA 30813-3610
(706) 833-6879
Mailing address
1264 NEWMANTOWN RD, GROVETOWN, GA 30813-3610
(706) 833-6879

Taxonomy

Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary

Other

Enumeration date
03/05/2021
Last updated
03/05/2021
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