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1205413507
CHEVIS M JACKSON
CUMMING, GA
NPI
1205413507
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: GA PTA003382)
Enumeration Date
2021-03-24
Last Update Date
2021-03-24
Business Address
CHEVIS M JACKSON
125 SAMARITAN DR
CUMMING, GA 30040-2354
Phone number: 770-889-1644
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Mailing Address
CHEVIS M JACKSON
1335 OAKSHYRE PL
LAWRENCEVILLE, GA 30043-6435
Phone number: 504-912-5169
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