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General NPI Number Information
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NPI Number | 1437360716
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Entity Type | Individual
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Provider Name | GLENDA S JACKSON RN C
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Gender | Female
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1701 HARDEE AVE
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City | FORT MCPHERSON
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State | GA
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Zip | 30330
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Country | US
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Telephone | 404-464-0266
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Fax | 404-464-0475
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Provider Business Mailing Address
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Address Line | 1741 CEDAR WALK LN
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City | CONLEY
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State | GA
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Zip | 30288-1745
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Country | US
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Telephone | 404-361-0853
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Fax | 404-464-0475
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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 | 163WP2201X
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Taxonomy Name | Ambulatory Care Registered Nurse
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License Number | RN083685
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License Number State | GA
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