Individual
NICOLE LEWIS JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3298 NORTHSIDE DR, MACON, GA 31210
(478) 475-1976
(478) 475-1946
Mailing address
3298 NORTHSIDE DR, MACON, GA 31210
(478) 475-1976
(478) 475-1946
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12511
GA
Other
Enumeration date
12/18/2006
Last updated
07/08/2007
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