Healthcare Provider Details

I. General information

NPI: 1376309484
Provider Name (Legal Business Name): JJD PROFESSIONAL CARE AND HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 IVY LN CHASE LOOP
DALLAS GA
30157-5599
US

IV. Provider business mailing address

236 IVY LN CHASE LOOP
DALLAS GA
30157-5599
US

V. Phone/Fax

Practice location:
  • Phone: 770-885-0391
  • Fax:
Mailing address:
  • Phone: 770-885-0391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. JUDITH E UGORJI
Title or Position: NP
Credential: NP
Phone: 770-885-0391