Healthcare Provider Details

I. General information

NPI: 1134084734
Provider Name (Legal Business Name): JAMIE FOULKS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 AVALON PKWY STE 200
MCDONOUGH GA
30253-3054
US

IV. Provider business mailing address

2020 AVALON PKWY STE 200
MCDONOUGH GA
30253-3054
US

V. Phone/Fax

Practice location:
  • Phone: 470-471-0310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number1-194806
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number1-194806
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1-194806
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: