Healthcare Provider Details

I. General information

NPI: 1609454271
Provider Name (Legal Business Name): JEFFENY JIMENEZ RUBIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4961 BUFORD HWY STE 201
CHAMBLEE GA
30341-3536
US

IV. Provider business mailing address

249 OAKMOOR CT
LAWRENCEVILLE GA
30043-2364
US

V. Phone/Fax

Practice location:
  • Phone: 470-509-4648
  • Fax:
Mailing address:
  • Phone: 678-907-5237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN262513
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN262513
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: