Individual
JACKIELENE ANNETTE NEVILLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 COMER AVE, COLUMBUS, GA 31904-8725
(706) 324-4061
Mailing address
2100 COMER AVE, COLUMBUS, GA 31904-8725
(706) 324-4061
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
58-2108870
—
GA
Enumeration date
11/09/2018
Last updated
11/09/2018
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