Healthcare Provider Details

I. General information

NPI: 1760891584
Provider Name (Legal Business Name): JOSHUA JARRETT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 18TH ST E
TIFTON GA
31794-3648
US

IV. Provider business mailing address

907 18TH ST E SUITE 150
TIFTON GA
31794-3643
US

V. Phone/Fax

Practice location:
  • Phone: 229-382-7120
  • Fax:
Mailing address:
  • Phone: 229-382-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number237614
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: