Healthcare Provider Details

I. General information

NPI: 1609246800
Provider Name (Legal Business Name): JEANNETTE HOKANSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CLEVELAND AVE SW SUITE 301
ATLANTA GA
30315-7129
US

IV. Provider business mailing address

1966 MARK TRL
DECATUR GA
30032-5347
US

V. Phone/Fax

Practice location:
  • Phone: 404-228-2222
  • Fax:
Mailing address:
  • Phone: 404-310-7226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number129491
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: