Individual
MRS. JOHNNIE LAMM JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD, LDN
Contact information
Practice address
1785 KEITH HILLS ROAD, LILLINGTON, NC 27546
(910) 814-2909
(910) 893-2167
Mailing address
PO BOX 1572, BUIES CREEK, NC 27506-1572
(910) 814-2909
(910) 893-2167
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
L000862
NC
Other
Enumeration date
05/02/2007
Last updated
07/08/2007
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