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NPI Code Detail

MEDICARE: MRS. JACINTA LAKE THOMAS DNP, APRN-C

MEDICARE: MRS. JACINTA LAKE THOMAS DNP, APRN-C
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
1363LF0000XFamily Nurse PractitionerRN117444GA

General Provider Information

NPI Number : 1972592699
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JACINTA LAKE THOMAS DNP, APRN-C
Provider Business Mailing Address
First Line : 1717 BENNETT DR
Second Line :
City : MCDONOUGH
State : GA
Zip : 30253-9039
Country : US
Telephone Number : 678-787-8647
Fax Number :
Provider Business Practice Location Address
First Line : 865 N HIGHLAND AVE NE
Second Line :
City : ATLANTA
State : GA
Zip : 30306-4565
Country : US
Telephone Number : 404-733-6089
Fax Number : 612-659-7101
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2005
Last Update Date : 03/06/2013

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