Individual
JACKLINE WANGA GATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1275 HIGHWAY 54 W STE 201, FAYETTEVILLE, GA 30214-4538
(770) 461-3776
(770) 461-3565
Mailing address
1275 HIGHWAY 54 W STE 201, FAYETTEVILLE, GA 30214-4538
(770) 461-3776
(770) 461-3565
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN313932
GA
363LF0000X
Family Nurse Practitioner
Primary
APRN-NP313932
GA
Other
Enumeration date
11/20/2019
Last updated
10/28/2025
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