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Individual

SHANTE JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1597 HOLLY BROOK RD, SNELLVILLE, GA 30078-2219
(203) 725-2004
Mailing address
PO BOX 871, SNELLVILLE, GA 30078-0871
(203) 725-2004

Taxonomy

Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
0014217458

Other

Enumeration date
04/17/2022
Last updated
04/17/2022
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