Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
LATRESE JACKSON
Active Sole ProprietorLATRESE JACKSON is a Prosthetic/Orthotic Supplier healthcare provider located in LIZELLA, Georgia. NPI 1295316511 is currently active in the NPPES registry. Verify at CMS.
Prosthetic/Orthotic Supplier · LIZELLA, GA
Registration Details
- NPI Number
- 1295316511
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Apr 19, 2021 (5.2945972857879 yrs)
- Last Updated
- Apr 19, 2021
- Sole Proprietor
- Yes
Practice Information
- Address
-
2324 GWENDALE DR WLIZELLA, GA, 310523550Browse GA providers · Browse ZIP 31052
- Phone
- 4782504601
- Primary Specialty
-
Prosthetic/Orthotic Supplier
335E00000X
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.