Provider Demographics
NPI:1639779481
Name:JEFFERSON, KAREN MARIA
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIA
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 RIDENOUR BLVD NW APT 1303
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4588
Mailing Address - Country:US
Mailing Address - Phone:240-988-9219
Mailing Address - Fax:
Practice Address - Street 1:1350 RIDENOUR BLVD NW APT 1303
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4588
Practice Address - Country:US
Practice Address - Phone:240-988-9219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant