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General NPI Number Information
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NPI Number | 1285598078
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Entity Type | Individual
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Provider Name | CHRISTANCIA JACKSON
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Gender | Female
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Dates
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Enumeration Date | 12/15/2025
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 5200 BLACK BEAR TRL
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-5832
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Country | US
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Telephone | 404-980-0313
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Fax |
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Provider Business Mailing Address
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Address Line | 5200 BLACK BEAR TRL
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-5832
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Country | US
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Telephone | 404-980-0313
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | CN0030057044
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License Number State | GA
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