MEDICARE: JAKAE WELLNESS LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1285561621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAKAE WELLNESS LLC

Provider Business Mailing Address
First Line	:	3324 PEACHTREE RD NE UNIT 1114
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1475
Country	:	US
Telephone Number	:	404-819-3980
Fax Number	:

Provider Business Practice Location Address
First Line	:	3324 PEACHTREE RD NE UNIT 1114
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1475
Country	:	US
Telephone Number	:	404-819-3980
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER AND CLLINICAL DIRECTOR
Name	:	KAWAJALEIN LATIC WHITAKER
Credential	:	APRN
Telephone Number	:	404-819-3980

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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