Healthcare Provider Details

I. General information

NPI: 1548788383
Provider Name (Legal Business Name): JINA CRAVEY ADAMS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 TELFAIR AVE
MC RAE HELENA GA
31055-4818
US

IV. Provider business mailing address

PO BOX 328
MC RAE HELENA GA
31055-0328
US

V. Phone/Fax

Practice location:
  • Phone: 229-868-7404
  • Fax: 229-868-7245
Mailing address:
  • Phone: 229-868-7404
  • Fax: 229-868-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN093180
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: