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General NPI Number Information
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NPI Number | 1144367749
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Entity Type | Individual
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Provider Name | NERISSA JACKSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 7386 FRIENDSHIP SPRINGS BLVD STE J
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-5548
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Country | US
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Telephone | 470-451-0646
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Fax | 470-451-0647
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Provider Business Mailing Address
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Address Line | PO BOX 1253
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City | SNELLVILLE
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State | GA
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Zip | 30078-1253
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Country | US
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Telephone | 315-403-4961
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA030340
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 013802
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7277
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License Number State | GA
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