Healthcare Provider Details

I. General information

NPI: 1386511145
Provider Name (Legal Business Name): JONELL BANKS FNP-BC
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: JONELLE BANKS

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 NORTHLAKE PKWY STE 211
TUCKER GA
30084-4006
US

IV. Provider business mailing address

347 WESTMINSTER DR
CANTON GA
30114-8824
US

V. Phone/Fax

Practice location:
  • Phone: 770-491-1344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP210500
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: