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Individual

MRS. PATRICE M JACKSON-WEATHERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CNA

Contact information

Practice address
4266 LINDSEY DR, DECATUR, GA 30035-1927
(470) 965-3741
Mailing address
325 WILLOW RIDGE WAY, AVONDALE ESTATES, GA 30002-1284
(470) 829-1973

Taxonomy

Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
376K00000X
Nurse's Aide
344541
WI
376K00000X
Nurse's Aide
560249
SC
376K00000X
Nurse's Aide
Primary
CN0014212008
GA

Other

Enumeration date
06/08/2015
Last updated
02/10/2024
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