Healthcare Provider Details

I. General information

NPI: 1649841644
Provider Name (Legal Business Name): JELANI CONWAY AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

487 WINN WAY
DECATUR GA
30030-1735
US

IV. Provider business mailing address

487 WINN WAY
DECATUR GA
30030-1735
US

V. Phone/Fax

Practice location:
  • Phone: 800-100-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD004280
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: