Provider Demographics
NPI:1003324112
Name:JARED L JARRETT NP, LLC
Entity Type:Organization
Organization Name:JARED L JARRETT NP, LLC
Other - Org Name:JARED L JARRETT, NP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NP, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:JARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:478-236-1135
Mailing Address - Street 1:1005 N CARMENVILLE DR
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-4221
Mailing Address - Country:US
Mailing Address - Phone:478-236-1135
Mailing Address - Fax:
Practice Address - Street 1:770 PINE ST STE 560
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7569
Practice Address - Country:US
Practice Address - Phone:478-236-1135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN198077363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty