Individual
NELSON JACQUET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
55 WHITCHER ST NE, STE 350, MARIETTA, GA 30060-1155
(770) 424-6893
(770) 424-9095
Mailing address
55 WHITCHER ST NE, STE 350, MARIETTA, GA 30060-1155
(770) 424-6893
(770) 424-9095
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004350
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180068957B
—
GA
05
—
180068957C
—
GA
05
—
180068957D
—
GA
05
—
180068957E
—
GA
05
—
180068957F
—
GA
Enumeration date
06/17/2005
Last updated
11/06/2019
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