Provider Demographics
NPI:1376008110
Name:JARRELL, JOANNA (NP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:JARRELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 FORSYTH ST STE 2E
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8631
Mailing Address - Country:US
Mailing Address - Phone:478-633-7330
Mailing Address - Fax:478-633-7360
Practice Address - Street 1:1062 FORSYTH ST STE 2E
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8631
Practice Address - Country:US
Practice Address - Phone:478-633-7330
Practice Address - Fax:478-633-7630
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN204712363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics