Individual
MR. ROBERT WALLACE JACKSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1355 TERRELL MILL RD SE BLDG 1462-125, MARIETTA, GA 30067-5559
(470) 632-7400
(470) 524-0500
Mailing address
1355 TERRELL MILL RD SE BLDG 1462-125, MARIETTA, GA 30067-5559
(470) 632-7400
(470) 524-0500
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
PHCP010932
GA
Other
Enumeration date
02/10/2021
Last updated
02/10/2021
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