Provider Demographics
NPI:1104611821
Name:JACKSON, TAMIA DESTINY (MSW)
Entity type:Individual
Prefix:
First Name:TAMIA
Middle Name:DESTINY
Last Name:JACKSON
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-5129
Mailing Address - Country:US
Mailing Address - Phone:912-256-4755
Mailing Address - Fax:
Practice Address - Street 1:71 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-5129
Practice Address - Country:US
Practice Address - Phone:912-256-4755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-12
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker