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LATRESE JACKSON
NPI 1295316511
Prosthetic/Orthotic Supplier in Lizella, GA

Active since April 19, 2021
2324 GWENDALE DR W, LIZELLA, GA 31052(478) 250-4601 Get Directions Write a Review

NPPES record last updated: April 19, 2021. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Latrese Jackson NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LATRESE JACKSON (NPI 1295316511) is an individual prosthetic/orthotic supplier provider in Lizella, Georgia and active in the NPI registry since April 2021.

NPPES Registry Identity

NPI1295316511
Entity TypeIndividualFemale
Primary Taxonomy335E00000X
Provider Legal NameLATRESE JACKSON
Location Address2324 GWENDALE DR WLizella, GA 31052-3550
Mailing Address2324 Gwendale Dr WLizella, GA 31052-3550 · (478) 250-4601
Phone(478) 250-4601
Sole ProprietorYes
Enumeration DateApril 19, 2021
NPPES CertifiedApril 19, 2021
✔ NPI 1295316511 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyProsthetic/Orthotic SupplierSuppliers
Taxonomy Code335E00000X
Definition
An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.
2324 GWENDALE DR W, Lizella, GA 31052
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Latrese Jackson's NPI number?

The NPI number for Latrese Jackson is 1295316511. It was assigned to this individual provider in the NPPES registry on April 19, 2021.

Where is Latrese Jackson located?

Latrese Jackson practices at 2324 Gwendale Dr W, Lizella, GA 31052. The listed phone number is (478) 250-4601.

What is Latrese Jackson's specialty?

The primary specialty registered for this NPI is Prosthetic/Orthotic Supplier with taxonomy code 335E00000X.

When was this NPI record last updated?

The NPPES record for Latrese Jackson was last updated on April 19, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.