Healthcare Provider Details

I. General information

NPI: 1386381010
Provider Name (Legal Business Name): JODI ROBERSON LOKEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. JODI ALICIA ROBERSON

II. Dates (important events)

Enumeration Date: 05/15/2022
Last Update Date: 05/15/2022
Certification Date: 05/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 ASHEVILLE DR
RINGGOLD GA
30736-7575
US

IV. Provider business mailing address

133 ASHEVILLE DR
RINGGOLD GA
30736-7575
US

V. Phone/Fax

Practice location:
  • Phone: 423-280-9086
  • Fax:
Mailing address:
  • Phone: 423-280-9086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN164957
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: