Healthcare Provider Details

I. General information

NPI: 1013741537
Provider Name (Legal Business Name): TRAMEKA LASHUN HARRIS JONES NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 ROADRUNNER BLVD
LA FAYETTE GA
30728-2161
US

IV. Provider business mailing address

1306 SHERWOOD DR
DALTON GA
30720-5155
US

V. Phone/Fax

Practice location:
  • Phone: 706-638-4662
  • Fax:
Mailing address:
  • Phone: 706-280-9295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN31464
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN314464
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: