Individual
ELIZABETH A. JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
745 POPLAR RD, NEWNAN, GA 30265-1618
(404) 367-3014
(404) 367-3558
Mailing address
745 POPLAR RD, NEWNAN, GA 30265-1618
(404) 367-3014
(404) 367-3558
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN146361
GA
363LA2200X
Adult Health Nurse Practitioner
Primary
RN146361
GA
364SG0600X
Gerontology Clinical Nurse Specialist
RN146361
GA
Other
Enumeration date
11/11/2014
Last updated
05/16/2016
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