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Individual

ANGELA JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
72 DRAYTON CT, MIDWAY, GA 31320-7142
(404) 697-3608
(904) 203-1226
Mailing address
72 DRAYTON CT, MIDWAY, GA 31320-7142

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-216258
171M00000X
Case Manager/Care Coordinator

Other

Enumeration date
01/05/2021
Last updated
05/22/2022
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