Individual
SHANEQUA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1204 HEMLOCK DR, AUGUSTA, GA 30909-2754
(706) 228-0321
Mailing address
1204 HEMLOCK DR, AUGUSTA, GA 30909-2754
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
06/29/2020
Last updated
06/29/2020
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