Individual
CHANDA WALLER JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
95 COLLIER RD NW STE 5015, ATLANTA, GA 30309-1721
(404) 605-6517
Mailing address
550 PEACHTREE STREET, DAVIS FISHER BUILDING, OFFICE 3245A, ATLANTA, GA 30308
(404) 686-7858
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
RN213894
GA
363L00000X
Nurse Practitioner
Primary
RN213894
GA
Other
Enumeration date
10/30/2017
Last updated
06/15/2023
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