Provider Demographics
NPI:1366043887
Name:JACKSON-PATTERSON, NANCY R (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:R
Last Name:JACKSON-PATTERSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 MAGNOLIA RDG
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-6070
Mailing Address - Country:US
Mailing Address - Phone:770-298-0961
Mailing Address - Fax:
Practice Address - Street 1:6211 MAGNOLIA RDG
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-6070
Practice Address - Country:US
Practice Address - Phone:770-298-0961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN177419163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology