Healthcare Provider Details

I. General information

NPI: 1679292122
Provider Name (Legal Business Name): DELANA LYNN JOB LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DELANA LYNN QUINONES

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 WHITE INGRAM PKWY
DALLAS GA
30132-0969
US

IV. Provider business mailing address

311 WHITE INGRAM PKWY # 301
DALLAS GA
30132-0969
US

V. Phone/Fax

Practice location:
  • Phone: 678-363-7447
  • Fax:
Mailing address:
  • Phone: 678-363-7447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN082688
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: