Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ida Desiree Jackson

Individual provider Physical Therapy Assistant · NPI 1639957434

Ida Desiree Jackson is a Physical Therapy Assistant in Macon, Georgia. Licensed in Georgia. Registered with an NPI since 2023.

Licensed in
GA
In the registry since
2023

Practice location Address checks out

291 Plantation Centre Dr N Apt 705
Macon, GA 31210-9249
Phone: (478) 447-7052
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence PTA002042 (GA)

Record details

NPI number1639957434
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedSeptember 21, 2023
Last updated in NPPESSeptember 21, 2023
Certification dateSeptember 21, 2023
Mailing address291 Plantation Centre Dr N Apt 705, Macon, GA 31210-9249

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