Individual
GEORGINA GRACE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
229 W 60TH ST APT 4U, NEW YORK, NY 10023-7509
(917) 940-2867
Mailing address
229 W 60TH ST APT 4U, NEW YORK, NY 10023-7509
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
09/11/2023
Last updated
10/29/2024
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