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General NPI Number Information
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NPI Number | 1538588264
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Entity Type | Organization
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Legal Business Name | JESTIA PATHWAYS LLC
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 6040 TURTLE PT
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City | MCDONOUGH
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State | GA
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Zip | 30252-6875
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Country | US
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Telephone | 678-663-8669
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Fax |
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Provider Business Mailing Address
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Address Line | 6040 TURTLE PT
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City | MCDONOUGH
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State | GA
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Zip | 30252-6875
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Country | US
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Telephone | 678-663-8669
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | MRS. ALEXIS MCCALLUM
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Credential |
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Telephone | 678-663-8669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | CN0028898127
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License Number State | GA
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