MEDICARE: JACQUELYN NICOLE MCDOWELL CPNP

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	363LP0200X	Pediatric Nurse Practitioner	RN177697 NP	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326373820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN NICOLE MCDOWELL CPNP

Provider Business Mailing Address
First Line	:	4000 SHAKERAG HL
Second Line	:	SUITE 201
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-4047
Country	:	US
Telephone Number	:	770-486-7111
Fax Number	:	770-486-7131

Provider Business Practice Location Address
First Line	:	4000 SHAKERAG HL
Second Line	:	SUITE 201
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-4047
Country	:	US
Telephone Number	:	770-486-7111
Fax Number	:	770-486-7131

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

Provider Enumeration Date	:	10/16/2009
Last Update Date	:	02/21/2012

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