Healthcare Provider Details

I. General information

NPI: 1487567905
Provider Name (Legal Business Name): JELITA LAW RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 CAMPBELLTON FAIRBURN RD
FAIRBURN GA
30213-2024
US

IV. Provider business mailing address

391 ROSEGLEN DR
MARIETTA GA
30066-5957
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number0001214207
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: