Individual
MRS. JUREA JUANITA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
351 S LIBERTY ST, WAYNESBORO, GA 30830-9686
(706) 554-4435
Mailing address
5028 RIVER RD, WAYNESBORO, GA 30830-7533
(706) 554-9923
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN074224
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPN074224
LPN LICENSE NUMBER
GA
Enumeration date
12/28/2007
Last updated
12/28/2007
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