Healthcare Provider Details

I. General information

NPI: 1568604817
Provider Name (Legal Business Name): JAKE BRENT METCALF RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 COLLIER RD NW STE 4025
ATLANTA GA
30309-1796
US

IV. Provider business mailing address

95 COLLIER RD NW STE 4025
ATLANTA GA
30309-1796
US

V. Phone/Fax

Practice location:
  • Phone: 404-872-8799
  • Fax: 404-874-3544
Mailing address:
  • Phone: 404-872-8799
  • Fax: 404-874-3544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN198678
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: