Provider Demographics
NPI:1518599018
Name:GETER-JACKSON, DE'JA Y
Entity Type:Individual
Prefix:
First Name:DE'JA
Middle Name:Y
Last Name:GETER-JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 N WOLFE ST UNIT 1706A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1190
Mailing Address - Country:US
Mailing Address - Phone:443-844-4498
Mailing Address - Fax:
Practice Address - Street 1:107 E 25TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5213
Practice Address - Country:US
Practice Address - Phone:410-558-0032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program