Individual
JACQUELYN HAIRSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
297 COOPER RD, LOGANVILLE, GA 30052-2518
(678) 381-2630
Mailing address
297 COOPER RD, LOGANVILLE, GA 30052-2518
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN299265
GA
Other
Enumeration date
09/26/2023
Last updated
09/26/2023
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