Individual
HEATHER M JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AA
Contact information
Practice address
11705 MERCY BLVD, SAVANNAH, GA 31419-1711
(912) 819-6000
Mailing address
6605 ABERCORN ST, SUITE 108, SAVANNAH, GA 31405-5815
(912) 354-5357
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
005442
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005442
PA LICENSES
GA
Enumeration date
10/16/2008
Last updated
06/16/2009
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