Individual
ITELYA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
6957 PINE SHADOW WAY, WINSTON, GA 30187-2150
(678) 540-4446
(678) 540-4426
Mailing address
8491 HOSPITAL DR # 135, DOUGLASVILLE, GA 30134-2412
(678) 540-4446
(678) 540-4426
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
12/23/2015
Last updated
12/23/2015
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