Individual
KELLY LEN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
771 OLD NORCROSS RD STE 165, LAWRENCEVILLE, GA 30046-4979
(678) 442-3121
Mailing address
771 OLD NORCROSS RD STE 165, LAWRENCEVILLE, GA 30046-4979
(678) 442-3121
(404) 255-1939
Taxonomy
Speciality
Code
Description
License number
State
163WX0200X
Oncology Registered Nurse
Primary
RN143526
GA
Other
Enumeration date
01/23/2009
Last updated
11/16/2025
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