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General NPI Number Information
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NPI Number | 1649875311
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Entity Type | Individual
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Provider Name | JOSE DANNYLO MEJIA JR. FNP
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Gender | Male
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 77 WEAVER RD STE B
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-3136
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Country | US
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Telephone | 706-439-6165
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Fax |
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Provider Business Mailing Address
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Address Line | 143 GRACE VALLEY WAY
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-4947
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Country | US
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Telephone | 706-970-1222
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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 | RN187555
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F10200522
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN187555
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License Number State | GA
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