Individual
NICOLETTE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1303 LOCKHAVEN CIR SW, ATLANTA, GA 30311-3521
(770) 912-8801
(770) 936-1937
Mailing address
1303 LOCKHAVEN CIR SW, ATLANTA, GA 30311-3521
(770) 912-8801
(770) 936-1937
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
CN0030036955
GA
Other
Enumeration date
01/18/2021
Last updated
01/18/2021
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