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General NPI Number Information
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NPI Number | 1134208929
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Entity Type | Individual
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Provider Name | ANNE MARIE JACKSON PT
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Gender | Female
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3200 SHAKERAG HL
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-6511
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Country | US
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Telephone | 770-487-0760
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Fax |
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Provider Business Mailing Address
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Address Line | 264 CLARIDGE CURV
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-2627
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Country | US
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Telephone | 678-545-0951
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT004476
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License Number State | GA
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