Healthcare Provider Details

I. General information

NPI: 1124726690
Provider Name (Legal Business Name): JAKARA DEONTAE HOOD RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 BOULEVARD NE
ATLANTA GA
30312-1208
US

IV. Provider business mailing address

1945 SAVOY DR APT 4104
ATLANTA GA
30341-1059
US

V. Phone/Fax

Practice location:
  • Phone: 404-665-8600
  • Fax: 404-665-8698
Mailing address:
  • Phone: 678-361-2547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN305827
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN305827
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: