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General NPI Number Information
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NPI Number | 1538953245
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Entity Type | Organization
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Legal Business Name | RUBY & PEARL WELLNESS
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 2180 SATELLITE BLVD STE 400
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City | DULUTH
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State | GA
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Zip | 30097-4927
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Country | US
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Telephone | 404-480-2760
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Fax | 949-703-8760
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Provider Business Mailing Address
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Address Line | 1052 ASHTON PARK DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-7277
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Country | US
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Telephone | 404-480-2760
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Fax | 949-703-8760
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Authorized Official
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Title or Position | OWNER
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Name | NICHELLE LATOYA JACKSON
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Credential | FNP-C, PMHNP-BC
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Telephone | 404-480-2760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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