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General NPI Number Information
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NPI Number | 1477881696
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Entity Type | Individual
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Provider Name | TERESA DANIELLE JACKSON D.C.
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Gender | Female
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Dates
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Enumeration Date | 11/29/2009
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5304 PANOLA INDUSTRIAL BLVD STE E
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City | DECATUR
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State | GA
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Zip | 30035-4065
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Country | US
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Telephone | 404-445-5032
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Fax | 404-845-7834
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Provider Business Mailing Address
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Address Line | 15 GUM CREEK LNDG
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City | OXFORD
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State | GA
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Zip | 30054-2743
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Country | US
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Telephone | 347-893-0213
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Fax | 770-817-0832
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR008462
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License Number State | GA
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