Jackson, Jeanine M.

Jackson, Jeanine M. is an individual health care provider with primary practice located at 725 Jesse Jewell Pkwy Se , Gainesville GA 30501-3834. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Neonatal, Physician Assistants & Advanced Practice Nursing Providers / Pediatrics. Physician Assistants & Advanced Practice Nursing Providers / Pediatrics is her primary health care specialty. Jackson, Jeanine M. can be contacted via phone (770) 535-3611.

Contact Information

Primary practice address
725 Jesse Jewell Pkwy Se Gainesville GA 30501-3834
Phone: (770) 535-3611
Fax: (770) 535-7092
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Neonatal 363LN0000X RN060702 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X RN060702 Georgia

Profile Details

NPI number 1568434231
LBN Legal business name Jackson, Jeanine M.
Credentials CNNP
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 6th, 2006
Last updated Oct 25th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568434231 NPPES
Georgia MEDICAID 000731497D
Georgia Other 302386
Georgia MEDICAID 000731497E
Georgia MEDICAID 000731497A
Georgia Other 302385
Georgia MEDICAID 000731497B
Georgia MEDICAID 000731497F
Georgia Other 302387
Georgia Other 10032991
Georgia Other 302375

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