Provider Demographics
NPI:1255678942
Name:JACKSON, KATHERINE LEIGH (RPH)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:LEIGH
Last Name:JACKSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 CARMIA DR SW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-6258
Mailing Address - Country:US
Mailing Address - Phone:404-346-9259
Mailing Address - Fax:404-346-9264
Practice Address - Street 1:3730 CARMIA DR SW
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-6258
Practice Address - Country:US
Practice Address - Phone:404-346-9259
Practice Address - Fax:404-346-9264
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist