Jackson, Latrese

Jackson, Latrese is an sole proprietor health care provider with primary practice located at 2324 Gwendale Dr W , Lizella GA 31052-3550. She recently has only one registered license in Suppliers / Prosthetic/Orthotic Supplier, which is considered as her primary health care specialty. Jackson, Latrese can be contacted via phone (478) 250-4601.

Contact Information

Primary practice address
2324 Gwendale Dr W Lizella GA 31052-3550
Phone: (478) 250-4601
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Prosthetic/Orthotic Supplier 335E00000X

Profile Details

NPI number 1295316511
LBN Legal business name Jackson, Latrese
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 19th, 2021
Last updated Apr 19th, 2021 - about 5 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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