Individual
NANCY JACKSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RN PNP
Contact information
Practice address
1115 GARREDD BLVD, AUGUSTA, GA 30909
(706) 854-9416
(706) 863-8523
Mailing address
1115 GARREDD BLVD, AUGUSTA, GA 30909
(706) 854-9416
(706) 863-8523
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R110128
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00876939A
—
GA
Enumeration date
03/31/2006
Last updated
07/08/2007
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