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General NPI Number Information
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NPI Number | 1053254805
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Entity Type | Individual
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Provider Name | SYDNEY JAKES
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Gender | Female
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Dates
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Enumeration Date | 04/14/2026
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Last Update Date | 04/14/2026
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Provider Practice Location Address
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Address Line | 989 MONTREAL RD
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City | CLARKSTON
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State | GA
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Zip | 30021-1336
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Country | US
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Telephone | 404-296-1211
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Fax | 404-296-1998
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Provider Business Mailing Address
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Address Line | PO BOX 438
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City | CLARKSTON
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State | GA
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Zip | 30021-0438
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Country | US
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Telephone | 404-296-1211
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Fax | 404-296-1998
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 209800000X
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Taxonomy Name | Legal Medicine (M.D./D.O.) Physician
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License Number | 307583
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License Number State | GA
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