MEDICARE: JONELL BANKS FNP-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
1	363LF0000X	Family Nurse Practitioner	APRN-NP210500	GA

General Provider Information

NPI Number	:	1386511145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONELL BANKS FNP-BC

Provider Business Mailing Address
First Line	:	347 WESTMINSTER DR
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-8824
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2260 NORTHLAKE PKWY STE 211
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-4006
Country	:	US
Telephone Number	:	770-491-1344
Fax Number	:

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

Provider Enumeration Date	:	10/17/2025
Last Update Date	:	04/06/2026

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