Individual
DOMINIQUE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5330 RUTLAND CT, POWDER SPRINGS, GA 30127-4785
(404) 913-6337
(404) 393-7473
Mailing address
5330 RUTLAND CT, POWDER SPRINGS, GA 30127-4785
(404) 913-6337
(404) 393-7473
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
12/29/2023
Last updated
12/29/2023
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