Individual
DR. NKENGE AYEOLA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5354 REYNOLDS ST STE 420, SAVANNAH, GA 31405-6011
(912) 920-2995
Mailing address
PO BOX 60879, SAVANNAH, GA 31420-0879
(912) 920-2995
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
058969
GA
207V00000X
Obstetrics & Gynecology Physician
35-084664
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000337650
ANTHEM
OH
05
—
106448409A
—
GA
05
—
2502787
—
OH
01
—
R84664
SUMMACARE
OH
Enumeration date
07/03/2006
Last updated
09/11/2011
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