Individual
MRS. JACQUELYNN W NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
108 ALEX FRENCH DR SW, MILLEDGEVILLE, GA 31061-4431
(478) 456-8967
(925) 218-5671
Mailing address
108 ALEX FRENCH DR SW, MILLEDGEVILLE, GA 31061-4431
(478) 456-8967
(925) 218-5671
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD000699
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
502912371B
—
GA
Enumeration date
01/12/2007
Last updated
06/28/2016
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