Provider Demographics
NPI:1659829687
Name:JARRELLS, VERONICA (PP)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:JARRELLS
Suffix:
Gender:F
Credentials:PP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 WALTER WAY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-6115
Mailing Address - Country:US
Mailing Address - Phone:678-387-8247
Mailing Address - Fax:
Practice Address - Street 1:198 WALTER WAY
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-6115
Practice Address - Country:US
Practice Address - Phone:678-387-8247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor