Healthcare Provider Details

I. General information

NPI: 1114608114
Provider Name (Legal Business Name): JACOVYA JAMONA SOLOMON CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 REYNOLDS ST # 4S
SAVANNAH GA
31405-6015
US

IV. Provider business mailing address

1010 CARROLL ST
SAVANNAH GA
31415-5239
US

V. Phone/Fax

Practice location:
  • Phone: 912-819-7982
  • Fax:
Mailing address:
  • Phone: 912-508-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberCN0030068023
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: