Healthcare Provider Details

I. General information

NPI: 1801667076
Provider Name (Legal Business Name): JADA MONET BEMBRY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 E 16TH AVE STE A
CORDELE GA
31015-4553
US

IV. Provider business mailing address

1007 E 16TH AVE STE A
CORDELE GA
31015-4553
US

V. Phone/Fax

Practice location:
  • Phone: 229-273-1716
  • Fax: 229-273-1720
Mailing address:
  • Phone: 229-273-1716
  • Fax: 229-273-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN-NP292033
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: