Alice Jackson
Technician, Attendant Care Provider in Moreland, GA. Individual provider (NPI-1).
NPI number1366090813
StatusActive
Last updated in NPPESAug 28, 2019
Details
- NPI
- 1366090813
- Entity type
- Individual (NPI-1)
- Name
- Alice Jackson
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Aug 28, 2019
- Last updated
- Aug 28, 2019
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3747A0650X | Technician, Attendant Care Provider | – | – | Yes |
Practice location
1389 Gordon RdMoreland, GA 30259-2541
Phone 770-251-8209
Mailing address
1389 Gordon RdMoreland, GA 30259-2541
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Attendant Care Provider providers in Moreland, GA
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