Individual
LOGAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3235 S CHEROKEE LN STE 1200, WOODSTOCK, GA 30188-4461
(678) 384-4911
Mailing address
3235 S CHEROKEE LN STE 1200, WOODSTOCK, GA 30188-4461
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/09/2026
Last updated
06/09/2026
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