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General NPI Number Information
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NPI Number | 1407601685
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Entity Type | Individual
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Provider Name | JAMISON MCKENZIE MORAN
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Gender | Female
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 140 MARTIN PALMER DR
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City | BRUNSWICK
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State | GA
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Zip | 31523-8285
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Country | US
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Telephone | 912-567-6660
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Fax | 833-606-0577
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Provider Business Mailing Address
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Address Line | 4196 HIGHWAY 62 412 STE A
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City | HARDY
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State | AR
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Zip | 72542-8002
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN259143
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License Number State | GA
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