Healthcare Provider Details

I. General information

NPI: 1265378889
Provider Name (Legal Business Name): JAMILA LANAE MENDEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 N EXPRESSWAY STE 121-123
GRIFFIN GA
30223-1753
US

IV. Provider business mailing address

1424 N EXPRESSWAY STE 121-123
GRIFFIN GA
30223-1753
US

V. Phone/Fax

Practice location:
  • Phone: 404-458-7747
  • Fax:
Mailing address:
  • Phone: 404-458-7747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP309385
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: