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Organization

RUBY & PEARL WELLNESS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
NICHELLE LATOYA JACKSON FNP-C, PMHNP-BC (OWNER)
(404) 480-2760
Entity
Organization

Contact information

Practice address
2180 SATELLITE BLVD STE 400, DULUTH, GA 30097-4927
(404) 480-2760
(949) 703-8760
Mailing address
1052 ASHTON PARK DR, LAWRENCEVILLE, GA 30045-7277
(404) 480-2760
(949) 703-8760

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
261QU0200X
Urgent Care Clinic/Center
363LP0808X
Psychiatric/Mental Health Nurse Practitioner

Other

Enumeration date
04/07/2025
Last updated
04/07/2025
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