Provider Demographics
NPI:1255086310
Name:JACKSON, MARCELLA (CNA/MAA)
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:CNA/MAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11400 WHITE BLUFF RD APT 75
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1546
Mailing Address - Country:US
Mailing Address - Phone:912-662-9253
Mailing Address - Fax:
Practice Address - Street 1:11400 WHITE BLUFF RD APT 75
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1546
Practice Address - Country:US
Practice Address - Phone:912-662-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide