Individual
CRYSTAL JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1585 HOLLOWAY RAY RD, MC INTYRE, GA 31054-2469
(478) 234-1166
Mailing address
1585 HOLLOWAY RAY RD, MC INTYRE, GA 31054-2469
(478) 234-1166
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN090801
GA
Other
Enumeration date
07/29/2015
Last updated
07/29/2015
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