Healthcare Provider Details

I. General information

NPI: 1174082697
Provider Name (Legal Business Name): JANA EDWARDS MARKS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 HIGHWAY 21 S STE H
SPRINGFIELD GA
31329-5244
US

IV. Provider business mailing address

459 HIGHWAY 119 S
SPRINGFIELD GA
31329-3021
US

V. Phone/Fax

Practice location:
  • Phone: 912-754-1035
  • Fax: 912-754-1037
Mailing address:
  • Phone: 912-754-0175
  • Fax: 912-754-2570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN216318
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: