Individual
MS. ANGELA C JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
5408 WELLBORN CREEK DR, LITHONIA, GA 30058-3549
(678) 418-7010
Mailing address
5408 WELLBORN CREEK DR, LITHONIA, GA 30058-3549
(678) 418-7010
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD002290
GA
Other
Enumeration date
12/01/2010
Last updated
12/01/2010
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