Healthcare Provider Details

I. General information

NPI: 1154087997
Provider Name (Legal Business Name): VICKIE LYNN JUMPER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CRESCENT CENTER PKWY STE 395
TUCKER GA
30084-7039
US

IV. Provider business mailing address

100 CRESCENT CENTER PKWY STE 395
TUCKER GA
30084-7039
US

V. Phone/Fax

Practice location:
  • Phone: 470-354-3231
  • Fax: 470-354-3131
Mailing address:
  • Phone: 470-354-3231
  • Fax: 470-354-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberRN190291
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: