Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
ATAVIA JACKSON, ST
Active Sole ProprietorATAVIA JACKSON, ST is a Contractor healthcare provider located in MORVEN, Georgia. NPI 1528550209 is currently active in the NPPES registry. Verify at CMS.
Contractor · MORVEN, GA
Registration Details
- NPI Number
- 1528550209
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- May 30, 2018 (8.1711817705888 yrs)
- Last Updated
- May 30, 2018
- Sole Proprietor
- Yes
Practice Information
- Address
-
5229 JACKSON RDMORVEN, GA, 316383934Browse GA providers · Browse ZIP 31638
- Phone
- 2295615507
- Primary Specialty
-
Contractor
171W00000X
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.