Individual
DONNA MICHELLE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3861 RADCLIFFE BLVD, DECATUR, GA 30034-6056
(140) 449-3563
Mailing address
3861 RADCLIFFE BLVD, DECATUR, GA 30034-6056
(140) 449-3563
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
05/15/2024
Last updated
05/15/2024
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