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General NPI Number Information
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NPI Number | 1649035791
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Entity Type | Individual
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Provider Name | KATHERINE JUSTINA JACKSON MSN, WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 10692 MEDLOCK BRIDGE RD STE 100A
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City | JOHNS CREEK
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State | GA
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Zip | 30097-8497
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Country | US
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Telephone | 404-446-2496
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Fax | 404-446-2497
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Provider Business Mailing Address
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Address Line | 3450 BLAIR CIR NE UNIT 1408
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City | BROOKHAVEN
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State | GA
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Zip | 30319-2243
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Country | US
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Telephone | 205-566-7869
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | GAA-NP004386
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License Number State | GA
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