Individual
KRISA FOREHAND JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, PA-C
Contact information
Practice address
442 GA HIGHWAY 57, MACON, GA 31217-2803
(478) 550-0212
Mailing address
442 GA HIGHWAY 57, MACON, GA 31217-2803
(478) 550-0212
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AT003814
GA
363A00000X
Physician Assistant
Primary
13715
GA
363A00000X
Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/06/2018
Last updated
03/18/2026
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