Provider Demographics
NPI:1144006552
Name:JACKS, CINDY CLORISE (CALT)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:CLORISE
Last Name:JACKS
Suffix:
Gender:F
Credentials:CALT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 HAMMOND DR.
Mailing Address - Street 2:BLDG 6 STE 350
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:470-962-9564
Mailing Address - Fax:
Practice Address - Street 1:750 HAMMOND DR.
Practice Address - Street 2:BLDG 6 STE 350
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:470-962-9564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty