Healthcare Provider Details

I. General information

NPI: 1841363488
Provider Name (Legal Business Name): JANICE M JEFFERSON BSN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1853 JONESBORO RD
ATLANTA GA
30315
US

IV. Provider business mailing address

99 JESSE HILL JR DRIVE SE ROOM 402
ATLANTA GA
30315
US

V. Phone/Fax

Practice location:
  • Phone: 404-624-0626
  • Fax:
Mailing address:
  • Phone: 404-370-1217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN040631
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN040631
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: