Healthcare Provider Details

I. General information

NPI: 1932032794
Provider Name (Legal Business Name): JKK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 BROXTON HWY
HAZLEHURST GA
31539-7089
US

IV. Provider business mailing address

235 BROXTON HWY
HAZLEHURST GA
31539-7089
US

V. Phone/Fax

Practice location:
  • Phone: 912-379-9009
  • Fax:
Mailing address:
  • Phone: 912-379-9009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES PETTIS
Title or Position: PRESIDENT
Credential:
Phone: 478-714-0246