Individual
MRS. AMANDA HOLLOMAN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
550 PEACHTREE ST NE STE 1275, ATLANTA, GA 30308-2240
(404) 872-3121
(404) 872-3119
Mailing address
550 PEACHTREE ST NE STE 1275, ATLANTA, GA 30308-2240
(404) 872-3121
(404) 872-3119
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN097491
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00311409A
—
GA
Enumeration date
10/06/2011
Last updated
11/18/2011
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