Individual
SHETIA DONYETTE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSW
Contact information
Practice address
4675 STONEWALL CIR, VALDOSTA, GA 31605-7575
(229) 328-7768
Mailing address
4675 STONEWALL CIR, VALDOSTA, GA 31605-7575
(229) 328-7768
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
02/01/2018
Last updated
02/01/2018
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