Individual
MELVIN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
745 POPLAR RD, NEWNAN, GA 30265-1618
(770) 400-2353
Mailing address
1066 ALMA DR, MACON, GA 31216-6195
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN-NP309363
GA
363LA2100X
Acute Care Nurse Practitioner
RN309363
GA
Other
Enumeration date
08/22/2025
Last updated
06/10/2026
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