Healthcare Provider Details

I. General information

NPI: 1629111786
Provider Name (Legal Business Name): JSB HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/02/2025
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BIG A RD
TOCCOA GA
30577-6013
US

IV. Provider business mailing address

1330 BIG A RD
TOCCOA GA
30577-6013
US

V. Phone/Fax

Practice location:
  • Phone: 706-886-3119
  • Fax: 706-886-3110
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1115016
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP PROVIDER IDENTIFICATION NUMBER
# 2
Identifier00447554A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name: JENNIFER BRAWNER
Title or Position: OWNER
Credential:
Phone: 706-886-3119