Individual
DR. NICOLE DENISE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DSW, LMSW
Contact information
Practice address
1017 FAYETTEVILLE RD SE, ATLANTA, GA 30316-2932
(678) 234-7239
Mailing address
1017 FAYETTEVILLE RD SE, ATLANTA, GA 30316-2932
(678) 234-7239
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
MSW007744
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000000000000
N/A
—
Enumeration date
01/12/2019
Last updated
01/12/2019
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