person
Kellontreia Laporche Jackson, A-GNP-C
Gerontology Nurse Practitioner in Decatur, Georgia
NPI 1619685534

Kellontreia Laporche Jackson is a Gerontology Nurse Practitioner based in Atlanta, GA and is specialized in Gerontology. Kellontreia Laporche Jackson practices in Decatur, GA and has the professional credentials of A-GNP-C. The NPI Number for Kellontreia Laporche Jackson is 1619685534 and holds a License No. RN259383 (Georgia).

The current practice location address for Kellontreia Laporche Jackson is 2732 Candler Rd, Decatur, GA and can be reached out via phone at 470-444-3133 and via fax at 470-276-4051. You can also correspond with Kellontreia Laporche Jackson through the mailing address at PO BOX 740013, ATLANTA, GA - 30374-0013 (mailing address contact number: 312-733-9730).

Location: 2732 Candler Rd, Decatur, GA, 30374-0013
person
Provider Profile Details
NPI Number
1619685534
Provider Name
Kellontreia Laporche Jackson
Credential
A-GNP-C
Provider Entity Type
Individual
Gender
Female
Address
2732 Candler Rd, Decatur, GA, 30374-0013
Phone Number
470-444-3133
Fax Number
470-276-4051
Provider Enumeration Date
11/09/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
2732 Candler Rd
City
State
Zip
30034-1410
Phone Number
470-444-3133
Fax Number
470-276-4051
person
Provider Business Mailing Address Details
Address
2732 Candler Rd
City
State
Zip
30034-1410
Phone Number
470-444-3133
Fax Number
470-276-4051
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Gerontology
Taxonomy
License No.
RN259383 (Georgia)
Definition
Definition to come...
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