Individual
MELODY JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
909 INDIAN LAKE DR NW, LILBURN, GA 30047-6807
(770) 990-6065
Mailing address
909 INDIAN LAKE DR NW, LILBURN, GA 30047-6807
(770) 990-6065
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT010006
GA
Other
Enumeration date
09/08/2025
Last updated
09/08/2025
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