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:
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Health care specialties

SpecialtyCodeLicense #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 15 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 1952360851 NPPES
Georgia MEDICAID 000887928

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