Healthcare Provider Details

I. General information

NPI: 1477060507
Provider Name (Legal Business Name): JERRI EMORY SA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2018
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 SPRING ST NE
GAINESVILLE GA
30501-3715
US

IV. Provider business mailing address

7380 SPOUT SPRINGS RD # 210-119
FLOWERY BRANCH GA
30542-7541
US

V. Phone/Fax

Practice location:
  • Phone: 770-530-2793
  • Fax:
Mailing address:
  • Phone: 770-530-2793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number17-200
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: