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General NPI Number Information
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NPI Number | 1528053816
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Entity Type | Individual
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Provider Name | KATHRYN HORTON JACKSON RPH
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Gender | Female
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5445 MERIDIAN MARKS RD NE SUITE 190
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City | ATLANTA
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State | GA
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Zip | 30342-4763
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Country | US
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Telephone | 404-459-1740
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Fax | 404-459-7145
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Provider Business Mailing Address
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Address Line | 2123 ADDERBURY LN SW
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City | SMYRNA
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State | GA
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Zip | 30082-3665
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Country | US
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Telephone | 770-850-4224
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH019300
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License Number State | GA
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