Provider Demographics
NPI:1851717979
Name:JEFFERSON, LINDA (LPN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3084 PARKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3600
Mailing Address - Country:US
Mailing Address - Phone:678-608-9561
Mailing Address - Fax:470-545-0594
Practice Address - Street 1:3084 PARKSIDE CT
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3600
Practice Address - Country:US
Practice Address - Phone:678-608-9561
Practice Address - Fax:470-545-0594
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN080747164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse