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NPI Code Detail

MEDICARE: MISS JACQUELYN DENISE OWENS APRN, CNS/PMH-BC

MEDICARE: MISS JACQUELYN DENISE OWENS APRN, CNS/PMH-BC
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
1163WP0808XPsychiatric/Mental Health Registered NurseRN115796GA

General Provider Information

NPI Number : 1184845513
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JACQUELYN DENISE OWENS APRN, CNS/PMH-BC
Provider Business Mailing Address
First Line : 3263 BOULDER BROOK DR
Second Line :
City : LITHONIA
State : GA
Zip : 30038-3004
Country : US
Telephone Number : 770-482-7184
Fax Number :
Provider Business Practice Location Address
First Line : 3188 ATLANTA RD SE
Second Line :
City : SMYRNA
State : GA
Zip : 30080-8256
Country : US
Telephone Number : 770-319-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 11/02/2011

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