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STEPHANIE S JACKSON
>> Contractor >> Other Service ProvidersRegistrant NPI Number: 1679143747
Individual Registrant: STEPHANIE S JACKSON
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
262 PEBBLE HILL CIR SYLVESTER, GA 31791-7759 US
Tel: 229-206-2767 Fax: --
Tel: 229-206-2767 Fax: --
Contact information for business:
262 PEBBLE HILL CIR SYLVESTER, GA 31791-7759 US
Tel: 229-206-2767 Fax: --
Tel: 229-206-2767 Fax: --
Registration Information:
NPI: 1679143747
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 171W00000X | Other Service Providers Contractor |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
