Provider Demographics
NPI:1477731354
Name:JACKSON, SABRINA DEVON
Entity Type:Individual
Prefix:MRS
First Name:SABRINA
Middle Name:DEVON
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 E HARRIS CIR
Mailing Address - Street 2:
Mailing Address - City:CUTHBERT
Mailing Address - State:GA
Mailing Address - Zip Code:39840-1270
Mailing Address - Country:US
Mailing Address - Phone:229-732-2814
Mailing Address - Fax:
Practice Address - Street 1:28 E HARRIS CIR
Practice Address - Street 2:
Practice Address - City:CUTHBERT
Practice Address - State:GA
Practice Address - Zip Code:39840-1270
Practice Address - Country:US
Practice Address - Phone:229-732-2814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0000057891171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator