Healthcare Provider Details

I. General information

NPI: 1992112718
Provider Name (Legal Business Name): JACQUELENE HAMER-MCGHEE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E. HOSPITAL RD
FORT GORDON GA
30905-5741
US

IV. Provider business mailing address

300 EAST HOSPITAL ROAD
FORT GORDON GA
30905-5741
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-3568
  • Fax:
Mailing address:
  • Phone: 706-787-3568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN164833
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN164833
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License NumberRN164833
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN164833
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN164833
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: