Healthcare Provider Details

I. General information

NPI: 1962334375
Provider Name (Legal Business Name): JAMILA LACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 STILL WATER LN
JEFFERSON GA
30549-7044
US

IV. Provider business mailing address

44 STILL WATER LN
JEFFERSON GA
30549-7044
US

V. Phone/Fax

Practice location:
  • Phone: 732-956-1962
  • Fax:
Mailing address:
  • Phone: 732-956-1962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: