Individual
AMANDA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
209 N CUTHBERT ST, COLQUITT, GA 39837-3518
(229) 758-4212
Mailing address
PO BOX 8866, GREENSBORO, NC 27419-0866
(866) 237-8936
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
APRN11019451
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
RN195072
GA
Other
Enumeration date
07/10/2017
Last updated
06/24/2022
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