Provider Demographics
NPI:1376601948
Name:MORAIS, JANNET MAUREEN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JANNET
Middle Name:MAUREEN
Last Name:MORAIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JANNET
Other - Middle Name:MAUREEN
Other - Last Name:MORAIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:8901 STONEBRIDGE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2210
Mailing Address - Country:US
Mailing Address - Phone:678-838-3000
Mailing Address - Fax:678-838-3155
Practice Address - Street 1:8901 STONEBRIDGE BLVD., SUITE 100
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134
Practice Address - Country:US
Practice Address - Phone:678-838-3000
Practice Address - Fax:678-838-3155
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4528363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical