Provider Demographics
NPI:1093696759
Name:JACKSON GEORGE SALON
Entity type:Organization
Organization Name:JACKSON GEORGE SALON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER COSMETOLOGIST
Authorized Official - Phone:404-798-5927
Mailing Address - Street 1:2321 DUNWOODY XING APT D
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-8216
Mailing Address - Country:US
Mailing Address - Phone:404-798-5927
Mailing Address - Fax:
Practice Address - Street 1:4705 ASHFORD DUNWOODY RD SUITE A LOFT 2
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-8216
Practice Address - Country:US
Practice Address - Phone:770-695-1491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies