Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
TREVIS SHANTELL JACKSON
ActiveTREVIS SHANTELL JACKSON is a Physical Medicine & Rehabilitation healthcare provider located in FAIRBURN, Georgia. NPI 1073321659 is currently active in the NPPES registry. Verify at CMS.
Physical Medicine & Rehabilitation · FAIRBURN, GA
Registration Details
- NPI Number
- 1073321659
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Dec 27, 2024 (1.6706005531881 yrs)
- Last Updated
- Dec 27, 2024
- Licenses
-
OTA000749 (GA)OTA000749 (GA)
Practice Information
- Address
-
7420 MISTYDAWN DRFAIRBURN, GA, 302134330Browse GA providers · Browse ZIP 30213
- Phone
- 6783618944
- Primary Specialty
-
Physical Medicine & Rehabilitation
208100000X
- Additional Specialty
- Physical Medicine & Rehabilitation
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.