Individual
MS. BIANCA JO JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2508 SHANNON CT, HEPHZIBAH, GA 30815-6633
(706) 284-1533
(706) 284-1533
Mailing address
2508 SHANNON CT, HEPHZIBAH, GA 30815-6633
(706) 284-1533
(706) 284-1533
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
GA
253Z00000X
In Home Supportive Care Agency
Primary
—
—
320700000X
Physical Disabilities Residential Treatment Facility
—
—
Other
Enumeration date
04/21/2021
Last updated
04/10/2022
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