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1932791993
ROBERT WALLACE JACKSON
MARIETTA, GA
NPI
1932791993
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
253Z00000X In Home Supportive Care
(Licence: GA PHCP010932)
Enumeration Date
2021-02-10
Last Update Date
2021-02-10
Business Address
Mr. ROBERT WALLACE JACKSON
1355 TERRELL MILL RD SE BLDG 1462-125
MARIETTA, GA 30067-5559
Phone number: 470-632-7400
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Mailing Address
Mr. ROBERT WALLACE JACKSON
1355 TERRELL MILL RD SE BLDG 1462-125
MARIETTA, GA 30067-5559
Phone number: 470-632-7400
Copy
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