Individual
MRS. JACQUELINE MARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
450 NORTHSIDE CHEROKEE BLVD, CANTON, GA 30115-8015
(770) 224-1000
(770) 224-2451
Mailing address
7703 FLOYD CURL DR, MC7977, SAN ANTONIO, TX 78229-3901
(210) 358-4000
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
840805
TX
363LP2300X
Primary Care Nurse Practitioner
Primary
RN163623
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
327389802
—
TX
01
—
327389803
CSHCN
TX
Enumeration date
08/23/2013
Last updated
04/29/2020
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