Healthcare Provider Details

I. General information

NPI: 1619374865
Provider Name (Legal Business Name): JAYME FJELD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 11/17/2024
Certification Date: 11/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 SKYVIEW DR UNIT 154
LITHIA SPRINGS GA
30122-5026
US

IV. Provider business mailing address

2727 SKYVIEW DR UNIT 154
LITHIA SPRINGS GA
30122-5026
US

V. Phone/Fax

Practice location:
  • Phone: 701-793-1634
  • Fax:
Mailing address:
  • Phone: 701-793-1634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR009430
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: