KELLONTREIA LAPORCHE JACKSON

DECATUR, GA
NPI1619685534
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LG0600X Nurse Practitioner, Gerontology
(Licence: GA  RN259383)
Enumeration Date2022-11-09
Last Update Date2023-08-03
Business Address
KELLONTREIA LAPORCHE JACKSON A-GNP-C
2732 CANDLER RD
DECATUR, GA 30034-1410
Phone number: 470-444-3133
Mailing Address
KELLONTREIA LAPORCHE JACKSON A-GNP-C
PO BOX 740013
ATLANTA, GA 30374-0013
Phone number: 312-733-9730
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