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Contact Information

JACKSON K MIZE, ATC
590 COBB AVENUE MD #0201
KENNESAW, GA30144
 Phone: 470-578-2786
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Athletic Trainer

2255A2300X
Indicates primary specialty

NPI Profile & details for JACKSON K MIZE · (Male)

NPI # 1881372829
Status Active
Credentials ATC
Entity Individual
Enumeration date 07/10/2023
Last updated 07/10/2023 - About 3 years ago
Sole proprietor 1 Yes
Identifiers
  • GA License # AT003505
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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