Individual
TWYLA DOUGLAS JACKSON I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN, CSO, LD
Contact information
Practice address
CLINICAL NUTRITION, 1000 JOHNSON FERRY RD NE, ATLANTA, GA 30342
(404) 432-2916
Mailing address
1704 SUMMIT VILLAGE LN, MARIETTA, GA 30066-5962
(404) 432-2916
Taxonomy
Speciality
Code
Description
License number
State
133VN1301X
Oncology Nutrition Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LD001282
STATE OF GEORGIA LICENSE
GA
Enumeration date
03/27/2020
Last updated
03/27/2020
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