National Provider Identifier Database

DENISE JACKSON
Prosthetist

An individual skilled in the practice, making, use, and application to individual cases of an artificial substitute for a missing body part, such as an arm or leg, eye or tooth, used for functional or cosmetic reasons, or both


Contact Information

DENISE JACKSON
11720 MEDLOCK BRIDGE RD STE 155
JOHNS CREEK, GA30097
Phone: 574-320-3549
Fax:
Website:
Specialty Taxonomy Code
* Prosthetist 224P00000X

* Indicates primary specialty

NPI Profile & details for DENISE JACKSON

NPI Number 1306330303
Credentials
Entity Individual
Enumeration date 06/21/2018
Last updated 06/27/2018 - About 8 years ago
Sole proprietor1 Yes
Identifiers
  • GA License #: CO124581
  • IN License #: BC29700281
Hospital affiliation n/a

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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