Individual
LATORYA JACKOSN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 COMER AVE, COLUMBUS, GA 31904-8725
(334) 363-0950
Mailing address
196 LEE ROAD 956, SALEM, AL 36874-2886
(334) 363-0950
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/31/2011
Last updated
10/31/2011
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