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General NPI Number Information
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NPI Number | 1336879857
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Entity Type | Individual
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Provider Name | JADA HYLAND
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Gender | Female
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Dates
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Enumeration Date | 06/16/2022
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 83 UPPER RIVERDALE RD
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City | RIVERDALE
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State | GA
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Zip | 30274
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Country | US
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Telephone | 770-961-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 720 WESTVIEW DR SW
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City | ATLANTA
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State | GA
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Zip | 30310-1458
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Country | US
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Telephone |
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 12031
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License Number State | GA
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