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General NPI Number Information
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NPI Number | 1023990561
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Entity Type | Organization
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Legal Business Name | ELIZABETH JACKSON
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 1446 HARPER ST
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City | AUGUSTA
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State | GA
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Zip | 30912-0012
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Country | US
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Telephone | 762-375-2396
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Fax |
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Provider Business Mailing Address
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Address Line | 4304 CANDLEBERRY GDN
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City | NORTH AUGUSTA
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State | SC
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Zip | 29860-7203
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | ELIZABETH JACKSON
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Credential | DPT
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Telephone | 912-585-4211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number |
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License Number State |
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