Individual
TANYA TAMARA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
968 BROOKMERE CT, ATLANTA, GA 30349-6866
(470) 633-0313
Mailing address
968 BROOKMERE CT, ATLANTA, GA 30349-6866
(470) 633-0313
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R242369
GA
Other
Enumeration date
04/28/2025
Last updated
04/28/2025
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