Jackson, Rebecca Suzanne

Jackson, Rebecca Suzanne is an individual health care provider with primary practice located at 725 Jesse Jewell Pkwy Se , Gainesville GA 30501-3834. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife, which is considered as her primary health care specialty. Jackson, Rebecca Suzanne can be contacted via phone (770) 297-2200.

Contact Information

Primary practice address
725 Jesse Jewell Pkwy Se Gainesville GA 30501-3834
Phone: (770) 297-2200
Fax: (770) 534-8139
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X RN136000 Georgia

Profile Details

NPI number 1679516173
LBN Legal business name Jackson, Rebecca Suzanne
Credentials Certified Nurse Midwife (CNM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2006
Last updated May 1st, 2013 - about 12 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 1679516173 NPPES
Georgia Other 1004732 AMERIGROUP
Georgia Other 340852 AMERIGROUP
Georgia MEDICAID 382185596A AMERIGROUP
Georgia MEDICAID 382185596E AMERIGROUP
Georgia MEDICAID 382185596G AMERIGROUP
Georgia MEDICAID 382185596D AMERIGROUP

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