Individual
MRS. MANEKIA K JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
210 CREEKSIDE CIR, AUSTELL, GA 30168-5532
(404) 906-3404
Mailing address
210 CREEKSIDE CIR, AUSTELL, GA 30168-5532
(404) 963-6148
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
20094362
GA
Other
Enumeration date
02/06/2021
Last updated
02/06/2021
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