Healthcare Provider Details

I. General information

NPI: 1982907754
Provider Name (Legal Business Name): J.M.B. QUALITY NURSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 SAPHIRE DR
MCDONOUGH GA
30252-8076
US

IV. Provider business mailing address

1420 SAPHIRE DR
MCDONOUGH GA
30252-8076
US

V. Phone/Fax

Practice location:
  • Phone: 678-216-7286
  • Fax:
Mailing address:
  • Phone: 678-216-7286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number303474
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: JONIKA MARIE ASHWELL
Title or Position: NURSE
Credential:
Phone: 315-565-8121