Individual
SUZAN JACKOVATZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN, LD
Contact information
Practice address
5528 RIDGEMOOR DR, BRASELTON, GA 30517-1226
(678) 997-7421
Mailing address
5528 RIDGEMOOR DR, BRASELTON, GA 30517-1226
(678) 997-7421
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
1217
SC
133V00000X
Registered Dietitian
Primary
LD001330
GA
Other
Enumeration date
06/05/2015
Last updated
06/05/2015
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