Healthcare Provider Details

I. General information

NPI: 1558084657
Provider Name (Legal Business Name): JANE NJONGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 BARRINGTON PL
MARIETTA GA
30066-4923
US

IV. Provider business mailing address

83 BARRINGTON PL
MARIETTA GA
30066-4923
US

V. Phone/Fax

Practice location:
  • Phone: 470-717-2952
  • Fax:
Mailing address:
  • Phone: 470-717-2952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberPHCP011069
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: