Individual
DR. AVANELLE V JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
208 SCRANTON CONNECTOR STE 117, BRUNSWICK, GA 31525-0560
(912) 264-5961
(912) 262-9499
Mailing address
208 SCRANTON CONNECTOR, SUITE 117, BRUNSWICK, GA 31525
(912) 264-5961
(912) 262-9499
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
78666
GA
207RN0300X
Nephrology Physician
MD.022645
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1491501
—
LA
Enumeration date
05/06/2006
Last updated
10/24/2017
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