Individual
JACQUIECE LIDDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
4357 BOXWOOD TRL, ELLENWOOD, GA 30294-6518
(678) 517-7897
Mailing address
4357 BOXWOOD TRAIL, ELLENWOOD, GA 30294
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
RN206975
GA
Other
Enumeration date
05/10/2017
Last updated
11/08/2025
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