Richard Jackson Jr.
Clinic/Center, Adult Day Care in Decatur, GA. Individual provider (NPI-1).
NPI number1144192568
StatusActive
Last updated in NPPESOct 24, 2025
Details
- NPI
- 1144192568
- Entity type
- Individual (NPI-1)
- Name
- Richard Jackson Jr.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Sep 23, 2025
- Certification date
- Sep 23, 2025
- Last updated
- Oct 24, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QA0600X | Clinic/Center, Adult Day Care | – | GA | Yes |
Practice location
811 Creste DrDecatur, GA 30035-4135
Phone 678-881-7888
Mailing address
811 Creste DrDecatur, GA 30035-4135
Phone 678-881-7888
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