Healthcare Provider Details

I. General information

NPI: 1912831736
Provider Name (Legal Business Name): JMC HEMATOLOGY AND ONCOLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1271 MARCELLE HEIGHTS PL
NORCROSS GA
30093-3943
US

IV. Provider business mailing address

1271 MARCELLE HEIGHTS PL
NORCROSS GA
30093-3943
US

V. Phone/Fax

Practice location:
  • Phone: 678-315-7014
  • Fax:
Mailing address:
  • Phone: 678-315-7014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JORGE L MENA
Title or Position: OWNER
Credential: FNP-BC
Phone: 678-315-7014