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General NPI Number Information
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NPI Number | 1376146274
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Entity Type | Individual
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Provider Name | MEYONCA JACKSON PHARMD,
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Gender | Female
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Dates
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Enumeration Date | 11/21/2020
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Last Update Date | 11/21/2020
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Provider Practice Location Address
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Address Line | 1045 SOUTHCREST DR
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6113
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Country | US
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Telephone | 678-289-0549
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Fax |
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Provider Business Mailing Address
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Address Line | 509 WYNCROFT WAY
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City | MCDONOUGH
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State | GA
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Zip | 30253-8020
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Country | US
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Telephone | 404-993-4068
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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 | 1835X0200X
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Taxonomy Name | Oncology Pharmacist
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License Number | RPH031536
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License Number State | GA
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