Healthcare Provider Details

I. General information

NPI: 1093289126
Provider Name (Legal Business Name): JO UNDERWOOD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 CASCADE PKWY SW
ATLANTA GA
30311-3090
US

IV. Provider business mailing address

3495 PIEDMONT RD NE
ATLANTA GA
30305-1717
US

V. Phone/Fax

Practice location:
  • Phone: 404-364-7285
  • Fax:
Mailing address:
  • Phone: 404-364-7285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP203374
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: