Individual
INDIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
545 OLD NORCROSS RD STE 200, LAWRENCEVILLE, GA 30046-3390
(678) 377-2833
(678) 502-7800
Mailing address
6315 ROBINS TRCE, STONE MOUNTAIN, GA 30087-4979
(404) 414-0866
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP013295
GA
Other
Enumeration date
09/30/2024
Last updated
10/03/2024
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