Jackson, Ida Desiree

Jackson, Ida Desiree is an individual health care provider with primary practice located at 291 Plantation Centre Dr N Apt 705 , Macon GA 31210-9249. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant, which is considered as her primary health care specialty. Jackson, Ida Desiree can be contacted via phone (478) 447-7052.

Contact Information

Primary practice address
291 Plantation Centre Dr N Apt 705 Macon GA 31210-9249
Phone: (478) 447-7052
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant 225200000X PTA002042 Georgia

Profile Details

NPI number 1639957434
LBN Legal business name Jackson, Ida Desiree
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 21st, 2023
Last updated Sep 21st, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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