Individual
LETREACE ANDREA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5984 BROOKSIDE CT SE, MABLETON, GA 30126-2896
(904) 487-2305
Mailing address
5984 BROOKSIDE CT SE, MABLETON, GA 30126-2896
(904) 487-2305
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN255613
GA
Other
Enumeration date
01/10/2017
Last updated
01/10/2017
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