Provider Demographics
NPI:1639597586
Name:PRITCHETT, JANA SUSAN (AGACNP)
Entity Type:Individual
Prefix:MS
First Name:JANA
Middle Name:SUSAN
Last Name:PRITCHETT
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 CHAROLAIS TRL
Mailing Address - Street 2:
Mailing Address - City:COHUTTA
Mailing Address - State:GA
Mailing Address - Zip Code:30710-9325
Mailing Address - Country:US
Mailing Address - Phone:706-537-4277
Mailing Address - Fax:
Practice Address - Street 1:1506 BROADRICK DR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3011
Practice Address - Country:US
Practice Address - Phone:706-278-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN077411363L00000X, 363LA2100X, 363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology