Individual
DR. BETHANY WALL JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2112 SHORTER AVE NW STE 240, ROME, GA 30165-2042
(706) 368-8575
(706) 204-9430
Mailing address
PO BOX 12938, C/O CLINIC MANAGEMENT, CALHOUN, GA 30703
(706) 602-7800
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
060642
GA
Other
Enumeration date
01/23/2008
Last updated
04/16/2024
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