Individual
JATAI JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15022 SUNNY RIDGE CT, WOODBRIDGE, VA 22191-3967
(202) 439-3667
Mailing address
15022 SUNNY RIDGE CT APT 203, WOODBRIDGE, VA 22191-3967
(202) 439-3667
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
12201
VA
Other
Enumeration date
04/12/2018
Last updated
12/02/2024
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