Healthcare Provider Details

I. General information

NPI: 1952727042
Provider Name (Legal Business Name): KEVIN JUSTIN JABLONSKY RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 CEDARCREST RD NW STE 350-184
ACWORTH GA
30101-9539
US

IV. Provider business mailing address

1041 SAVANNAH LN
CALERA AL
35040-5406
US

V. Phone/Fax

Practice location:
  • Phone: 470-336-8190
  • Fax: 404-464-0781
Mailing address:
  • Phone: 205-250-9966
  • Fax: 205-358-3103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN220938
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: