Provider Demographics
NPI:1689309288
Name:JACKSON, AMBER KAY (DC)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:KAY
Last Name:JACKSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 KENTMERE MAIN NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6141
Mailing Address - Country:US
Mailing Address - Phone:404-807-9290
Mailing Address - Fax:
Practice Address - Street 1:85 GOLF CREST DR STE 201
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-2698
Practice Address - Country:US
Practice Address - Phone:770-443-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor