Individual
AMANDA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1269 BARCLAY CIR SE, MARIETTA, GA 30060-2903
(919) 370-0423
Mailing address
102 WETHERSFIELD DR, CARY, NC 27513-4965
(919) 370-0423
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT003082
GA
2255A2300X
Athletic Trainer
LAT-2819
NC
Other
Enumeration date
04/14/2017
Last updated
04/14/2017
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