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General NPI Number Information
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NPI Number | 1770468027
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Entity Type | Individual
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Provider Name | ELAINE JACKSON NP
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Gender | Female
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 1601 WATSON BLVD
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City | WARNER ROBINS
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State | GA
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Zip | 31093-3431
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Country | US
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Telephone | 478-922-4281
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Fax |
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Provider Business Mailing Address
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Address Line | 83 CLIFFHAVEN CIR
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City | NEWNAN
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State | GA
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Zip | 30263-5773
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Country | US
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Telephone | 478-972-3035
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN164249
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License Number State | GA
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