Individual
ROGER LEE JACKSON II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
713 CLIFTON RD SE, ATLANTA, GA 30316-2229
(404) 246-5444
Mailing address
713 CLIFTON RD SE, ATLANTA, GA 30316-2229
(404) 246-5444
Taxonomy
Speciality
Code
Description
License number
State
146M00000X
Intermediate Emergency Medical Technician
Primary
40076
GA
Other
Enumeration date
04/20/2020
Last updated
04/20/2020
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