DEPARTMENT OF INSURANCE

Name	Jackson, Dominique Ann	DOIID	826779	NAIC NPN	17104714

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date	Designated Home State
Active	Non Resident	Agent	Health	9/13/2023		4/30/2025
Inactive	Non Resident	Agent	Personal Lines	11/6/2013	4/30/2015

*If a status is Pending, Pending Replacement,or the record displays Affidavit on File, click on them for more details.

License Renewal Information

Class	Invoice Date	Response Due / Expiration Date	Response Received Date	Payment Received Date	Renewal Complete
Agent	02/15/2025	04/30/2025

NOTE: Licensee may renew up to 6 months prior to Next Compliance Date. Licensees subject to CE must complete CE requirements before Next Compliance Date in order to successfully complete the License Renewal Process.

Address Information

Type	Address
Business / Home Office	6818 Parkway Dr Lithonia, GA 300584534
Residence	Not Public Information

Phone Information

Type	Phone
Business / Home Office	(770) 589-8662