Healthcare Provider Details

I. General information

NPI: 1407776883
Provider Name (Legal Business Name): JONNAE L PAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 LABONTE PKWY
MCDONOUGH GA
30253-8123
US

IV. Provider business mailing address

1730 LABONTE PKWY
MCDONOUGH GA
30253-8123
US

V. Phone/Fax

Practice location:
  • Phone: 678-414-6625
  • Fax: 678-414-6625
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: