Provider Demographics
NPI:1467850578
Name:ANDRADE, JAYNE N (DNP)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:N
Last Name:ANDRADE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 DALLAS HWY STE 200-193
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-6318
Mailing Address - Country:US
Mailing Address - Phone:404-282-8530
Mailing Address - Fax:
Practice Address - Street 1:707 WHITLOCK AVE SW STE A40
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4654
Practice Address - Country:US
Practice Address - Phone:404-282-8530
Practice Address - Fax:404-282-8540
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN177136363LF0000X, 363LP0808X
GAF1014844363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily