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General NPI Number Information
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NPI Number | 1588108922
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Entity Type | Individual
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Provider Name | JENEAN ALESHA GARDNER BROOKS
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Gender | Female
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Dates
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Enumeration Date | 12/04/2016
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Last Update Date | 04/22/2019
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Provider Practice Location Address
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Address Line | 2945 PANOLA RD
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City | LITHONIA
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State | GA
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Zip | 30038-2313
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Country | US
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Telephone | 678-732-1518
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Fax | 404-614-7358
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Provider Business Mailing Address
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Address Line | 1950 BRIDGESTONE CIR
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City | CONYERS
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State | GA
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Zip | 30012-3793
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Country | US
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Telephone | 678-770-2470
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN202341
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License Number State | GA
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