Jackson, Larette Denise
Jackson, Larette Denise is an individual health care provider with primary practice located at 2451 Cumberland Pkwy Se Ste #3414, Atlanta GA 30339-6136. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Jackson, Larette Denise can be contacted via phone (832) 283-7792.Contact Information
Primary practice address
2451 Cumberland Pkwy Se Ste #3414
Atlanta GA 30339-6136
Phone: (832) 283-7792
Fax:
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered | 367500000X | RN104440 | Georgia |
Profile Details
NPI number | 1952360851 |
---|---|
LBN Legal business name | Jackson, Larette Denise |
Credentials | Certified Registered Nurse Anesthetist (CRNA) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Mar 20th, 2006 |
Last updated | Feb 18th, 2009 - about 16 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1952360851 | NPPES |
Georgia | MEDICAID | 000887928 |
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