Latrese Jackson
Latrese Jackson is a Prosthetic/Orthotic Supplier in Lizella, Georgia. Practices as a sole proprietor. Registered with an NPI since 2021.
- In the registry since
- 2021
Practice location Address checks out
2324 Gwendale Dr WLizella, GA 31052-3550
Phone: (478) 250-4601
Show map & directions
Directions in Google Maps · Apple Maps · OpenStreetMap
Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Prosthetic/Orthotic Supplier (primary) | Taxonomy 335E00000X |
|---|
Record details
| NPI number | 1295316511 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Female |
| Sole proprietor | Yes |
| NPI enumerated | April 19, 2021 |
| Last updated in NPPES | April 19, 2021 |
| Certification date | April 19, 2021 |
| Mailing address | 2324 Gwendale Dr W, Lizella, GA 31052-3550 |
Other providers in Lizella
-
Aria London Boutique
2311 Gwendale Dr E, Lizella, GA 31052-3524 · (478) 250-4601