Individual
JENEICIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
270 HERITAGE WALK, WOODSTOCK, GA 30188-3875
(678) 494-5700
Mailing address
905 GRIER ST APT 203, WOODSTOCK, GA 30189-3495
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN101803
GA
Other
Enumeration date
04/24/2024
Last updated
04/24/2024
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