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Latrese Jackson
Prosthetic/Orthotic Supplier in Lizella, Georgia
NPI 1295316511

Latrese Jackson is a Prosthetic/Orthotic Supplier based in Lizella, GA. Latrese Jackson practices in Lizella, GA. The NPI Number for Latrese Jackson is 1295316511 and holds a License No. (Georgia).

The current practice location address for Latrese Jackson is 2324 Gwendale Dr W, Lizella, GA and can be reached out via phone at 478-250-4601.

Location: 2324 Gwendale Dr W, Lizella, GA, 31052-3550
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1295316511
Provider Name
Latrese Jackson
Credential
Provider Entity Type
Individual
Gender
Female
Address
2324 Gwendale Dr W, Lizella, GA, 31052-3550
Phone Number
478-250-4601
Fax Number
Provider Enumeration Date
04/19/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
2324 Gwendale Dr W
City
Lizella
State
Georgia
Zip
31052-3550
Phone Number
478-250-4601
Fax Number
person
Provider Business Mailing Address Details
Address
2324 Gwendale Dr W
City
Lizella
State
Georgia
Zip
31052-3550
Phone Number
478-250-4601
Fax Number
person
Provider's Taxonomy Details 1
Type
Suppliers
Classification
Prosthetic/Orthotic Supplier
Speciality
-
Taxonomy
335E00000X
License No.
()
Definition
An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.
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