Individual provider · NPI-1

Miranda Jacko

Massage Therapist · Lithonia, GA

NPI number1740159656
StatusActive
Last updated in NPPESOct 30, 2025

Details

NPI
1740159656
Entity type
Individual (NPI-1)
Name
Miranda Jacko
Sex
Female
Sole proprietor
No
Enumeration date
Oct 30, 2025
Certification date
Oct 30, 2025
Last updated
Oct 30, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225700000X Massage TherapistMT015470GAYes

Practice location

7245 Rockbridge Rd Ste 600
Lithonia, GA 30058-8615

Phone 470-415-0471

Mailing address

615 Oakview Trl
Stone Mountain, GA 30087-6611

Phone 470-448-9452

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