Individual
MR. ANTOINE TREVOR JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAPC
Contact information
Practice address
1475 MECASLIN ST NW APT 7306, ATLANTA, GA 30309-2287
(404) 925-2276
Mailing address
1475 MECASLIN ST NW APT 7306, ATLANTA, GA 30309-2287
(404) 925-2276
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
002389
GA
Other
Enumeration date
03/11/2011
Last updated
03/11/2011
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