Healthcare Provider Details

I. General information

NPI: 1316842511
Provider Name (Legal Business Name): EMILY ROSE JUNEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 MCAFEE RD
DECATUR GA
30032-4238
US

IV. Provider business mailing address

2704 MCAFEE RD
DECATUR GA
30032-4238
US

V. Phone/Fax

Practice location:
  • Phone: 504-858-2496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: