Individual
RUSSELL EMANUEL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AT
Contact information
Practice address
406 SHERIDAN FOREST RD, GOLDSBORO, NC 27534-7103
(419) 215-8888
Mailing address
406 SHERIDAN FOREST RD, GOLDSBORO, NC 27534-7103
(419) 215-8888
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0005240
OH
Other
Enumeration date
07/23/2017
Last updated
08/03/2021
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