Individual
AMELIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-5541
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 435-5541
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
740612
TX
163WA2000X
Administrator Registered Nurse
Primary
740612
TX
163WC0400X
Case Management Registered Nurse
740612
TX
163WP0200X
Pediatric Registered Nurse
740612
TX
163WP2201X
Ambulatory Care Registered Nurse
740612
TX
Other
Enumeration date
09/30/2014
Last updated
09/30/2014
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