Individual
MS. JACKIE SHANNON MEADOWS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1948 HEATHROW DR, HINESVILLE, GA 31313-9412
(912) 369-4014
Mailing address
1948 HEATHROW DR, HINESVILLE, GA 31313-9412
(912) 369-4014
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00888654A
—
GA
Enumeration date
12/15/2006
Last updated
07/08/2007
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