Jackson, Sally
Jackson, Sally is an sole proprietor health care provider with primary practice located at 5150 Stilesboro Rd Nw Suite 430, Kennesaw GA 30152-7744. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics, which is considered as her primary health care specialty. Jackson, Sally can be contacted via phone (770) 630-0053.Contact Information
Primary practice address
5150 Stilesboro Rd Nw Suite 430
Kennesaw GA 30152-7744
Phone: (770) 630-0053
Fax: (770) 218-2201
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pediatrics | 225XP0200X | OT001398 | Georgia |
Profile Details
| NPI number | 1538383419 |
|---|---|
| LBN Legal business name | Jackson, Sally |
| Credentials | Occupational Therapist (OT) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 12th, 2007 |
| Last updated | Aug 17th, 2016 - about 8 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1538383419 | NPPES |
| Georgia | MEDICAID | 000611289C |
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