Individual
ANDREA ROLANDA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
1202 TOWN PARK LN STE 300, EVANS, GA 30809-3477
(706) 432-6866
Mailing address
864 LAKE ROYAL DR, GROVETOWN, GA 30813-4516
(443) 822-6648
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN186919
GA
Other
Enumeration date
09/13/2021
Last updated
11/27/2023
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