| Doctor Name: | MRS. SOPHIA EVETTE JACKSON |
| NPI Number: | 1093879769 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | RN117221 |
| Business Practice Address: | 1950 Buford Hwy Cvs Caremark Minute Clinic Buford, GA - 305183673 |
| Business Phone Number: | 7709457286 |
| Business Fax Number: | |
| Mailing Address: | 4249 Brentwood Dr, BUFORD |
| State: | GA |
| Postal Code: | 305189008 |
| Phone Number: | 7702928634 |
| Fax Number: | 7709652269 |
| NPI Enumeration Date: | 12/20/2006 |
| NPI Last Update Date: | 09/16/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN117221 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |