Healthcare Provider Details

I. General information

NPI: 1669209052
Provider Name (Legal Business Name): NAKIAH JANAE WILCOX FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5618B WHITE BLUFF RD
SAVANNAH GA
31405-5520
US

IV. Provider business mailing address

6004 EDISON AVE
SAVANNAH GA
31406-2916
US

V. Phone/Fax

Practice location:
  • Phone: 912-438-6803
  • Fax:
Mailing address:
  • Phone: 912-412-9498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN288325
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberRN288325
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberRN288325
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN288325
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: