Provider Demographics
NPI:1326373820
Name:MCDOWELL, JACQUELYN NICOLE (CPNP)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:NICOLE
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 SHAKERAG HL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4047
Mailing Address - Country:US
Mailing Address - Phone:770-486-7111
Mailing Address - Fax:770-486-7131
Practice Address - Street 1:4000 SHAKERAG HL
Practice Address - Street 2:SUITE 201
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4047
Practice Address - Country:US
Practice Address - Phone:770-486-7111
Practice Address - Fax:770-486-7131
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN177697 NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA208812066AMedicaid