Randy H Jackson PA

NPI 1629010707 - Physician Assistant - 363AM0700X

NPI Details
NPI 1629010707
Gender Male
Enumeration Date 06/12/2006
Last Updated 11/07/2007
Entity Type Individual
Active Over 10 years ago
Practice Location
GAINESVILLE GA, 30501-3715, US
Phone (770) 536-2146
Fax (770) 536-7895
Business Location
PO BOX 2938
GAINESVILLE GA, 30503-2938, US
Phone (770) 536-2146
Fax (770) 536-7895
Taxonomy Code 363AM0700X
License State Georgia
License Number 002048
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According to our database, Randy H Jackson PA NPI is 1629010707, taxonomy code is 363AM0700X and license number is 002048, license state is located at Georgia. Randy H Jackson PA physically located at 743 Spring St Ne, Gainesville GA, 30501-3715. NPI Number Randy H Jackson PA has the Individual type.

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1629010707 NPI number is provided on an as is basis without warranty of any kind. 1629010707 is maintained by the National Plan & Provider Enumeration System. The contents of Randy H Jackson PA are for informational purposes only.