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Individual

KIERNEY ELIZABETH JACKSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
200 S ENOTA DR NE STE 360, GAINESVILLE, GA 30501-3466
(770) 219-4000
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-02288
NC
363A00000X
Physician Assistant
1397
SC
363A00000X
Physician Assistant
Primary
7782
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0949PA
SC
05
1003057621
NC
Enumeration date
03/11/2009
Last updated
09/25/2025
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