Provider Demographics
NPI:1770643876
Name:JACKSON, BRIDGITTE L (FNP, AOCN)
Entity Type:Individual
Prefix:MS
First Name:BRIDGITTE
Middle Name:L
Last Name:JACKSON
Suffix:
Gender:F
Credentials:FNP, AOCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1071
Mailing Address - Country:US
Mailing Address - Phone:678-288-9555
Mailing Address - Fax:678-288-9556
Practice Address - Street 1:6300 HOSPITAL PKWY STE 300
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1982
Practice Address - Country:US
Practice Address - Phone:770-623-8965
Practice Address - Fax:770-623-4018
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN095124 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000809487AEMedicaid