Provider Demographics
NPI:1417616475
Name:SCURRY, JELEESA POPE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JELEESA
Middle Name:POPE
Last Name:SCURRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JELEESA
Other - Middle Name:AVETT
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:140 CEDAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-2200
Mailing Address - Country:US
Mailing Address - Phone:678-603-9861
Mailing Address - Fax:
Practice Address - Street 1:175 GWINNETT DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8444
Practice Address - Country:US
Practice Address - Phone:678-209-2394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN215474163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse