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Individual

KIMBERLY JACKSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
R.D.N..

Contact information

Practice address
2318 LONGCOURT WAY SE, ATLANTA, GA 30339-0902
(404) 889-7662
Mailing address
2318 LONGCOURT WAY SE, ATLANTA, GA 30339-0902

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
2230
AL
133V00000X
Registered Dietitian
Primary
LD004676
GA

Other

Enumeration date
12/10/2016
Last updated
12/10/2016
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