MEDICARE: JESTIA PATHWAYS 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	251J00000X	Nursing Care Agency	CN0028898127	GA

General Provider Information

NPI Number	:	1538588264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JESTIA PATHWAYS LLC

Provider Business Mailing Address
First Line	:	6040 TURTLE PT
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30252-6875
Country	:	US
Telephone Number	:	678-663-8669
Fax Number	:

Provider Business Practice Location Address
First Line	:	6040 TURTLE PT
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30252-6875
Country	:	US
Telephone Number	:	678-663-8669
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	MRS. ALEXIS MCCALLUM
Credential	:
Telephone Number	:	678-663-8669

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	04/09/2014

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Directions to “JESTIA PATHWAYS LLC ” Practice Location

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