Healthcare Provider Details

I. General information

NPI: 1912825340
Provider Name (Legal Business Name): JEAN CHARLES-LONCHARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3197 OVERLOOK HILL PASS
DACULA GA
30019-5108
US

IV. Provider business mailing address

3197 OVERLOOK HILL PASS
DACULA GA
30019-5108
US

V. Phone/Fax

Practice location:
  • Phone: 470-367-9654
  • Fax:
Mailing address:
  • Phone: 470-367-9654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN331900
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: