JACKSON KEITH MIZE

KENNESAW, GA
NPI1881372829
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: GA  AT003505)
Enumeration Date2023-07-10
Last Update Date2023-07-10
Business Address
JACKSON KEITH MIZE ATC
590 COBB AVENUE MD #0201
KENNESAW, GA 30144
Phone number: 470-578-2786
Mailing Address
JACKSON KEITH MIZE ATC
3091 COBB PKWY NW APT 1334
KENNESAW, GA 30152-8000
Phone number: 256-509-5364
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