Individual
JACKIE MARYLINE BASSONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C, FNP-BC
Contact information
Practice address
8 PERIMETER CTR E APT 1414, ATLANTA, GA 30346-1676
(770) 628-2500
(770) 628-2550
Mailing address
170 DUNAGAN DR, LAWRENCEVILLE, GA 30045-9017
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
RN279714
GA
Other
Enumeration date
04/18/2022
Last updated
12/22/2023
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