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Letreace Jackson
NPI 1932645389 · on the registry since 2017 · sole proprietor
Practice
- Address
- 5984 Brookside Ct Se
Mableton, GA 30126 - Phone
- (904) 487-2305
Registry record
- Primary taxonomy
- 163W00000X
163W00000X
- Licence states on file
- GA
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2017-01-10
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Georgia