MEDICARE: MRS. JACQUELINE MARIE BARTHOLOMEW NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN281188	GA

General Provider Information

NPI Number	:	1184246886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE MARIE BARTHOLOMEW NP

Provider Business Mailing Address
First Line	:	3781 CAPTAIN DR
Second Line	:
City	:	CHAMBLEE
State	:	GA
Zip	:	30341-2205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1465 HOWELL MILL RD NW STE 300A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-4246
Country	:	US
Telephone Number	:	404-254-5905
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2020
Last Update Date	:	12/11/2023

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