Provider Demographics
NPI:1346901931
Name:JACKSON-CAMPBELL, GABRIELLE (LN)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:
Last Name:JACKSON-CAMPBELL
Suffix:
Gender:F
Credentials:LN
Other - Prefix:
Other - First Name:BRIE
Other - Middle Name:
Other - Last Name:JACKSON-CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LN
Mailing Address - Street 1:794 MARIETTA ST NW # 950-321
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-5746
Mailing Address - Country:US
Mailing Address - Phone:404-324-2820
Mailing Address - Fax:
Practice Address - Street 1:794 MARIETTA ST NW # 950-321
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-5746
Practice Address - Country:US
Practice Address - Phone:404-324-2820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty