Individual
DR. JACQUELYN GERALDINE SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3909 NEW VISION DR, FORT WAYNE, IN 46845-1725
(260) 469-6610
(260) 969-3065
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02007766A
IN
207Q00000X
Family Medicine Physician
5101025847
MI
Other
Enumeration date
05/15/2019
Last updated
09/03/2024
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