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General NPI Number Information
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NPI Number | 1003324112
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Entity Type | Organization
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Legal Business Name | JARED L JARRETT NP, LLC
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Dates
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Enumeration Date | 01/11/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 770 PINE ST STE 560
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City | MACON
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State | GA
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Zip | 31201-7569
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Country | US
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Telephone | 478-236-1135
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 N CARMENVILLE DR
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City | BONAIRE
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State | GA
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Zip | 31005-4221
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Country | US
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Telephone | 478-236-1135
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Fax |
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Authorized Official
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Title or Position | NP, OWNER
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Name | MR. JARED LEWIS JARRETT
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Credential | NP
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Telephone | 478-236-1135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN198077
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License Number State | GA
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