Individual
LARETTE DENISE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2451 CUMBERLAND PKWY SE, STE #3414, ATLANTA, GA 30339-6136
(832) 283-7792
Mailing address
2451 CUMBERLAND PKWY SE, STE #3414, ATLANTA, GA 30339-6136
(770) 596-3498
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN104440
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000887928
—
GA
Enumeration date
03/20/2006
Last updated
02/18/2009
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