Provider Demographics
NPI:1013590280
Name:ROSS, JAHID KWAKU (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:JAHID
Middle Name:KWAKU
Last Name:ROSS
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:MR
Other - First Name:JAHID
Other - Middle Name:KWAKU
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:2816 RALEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-4734
Mailing Address - Country:US
Mailing Address - Phone:336-986-4623
Mailing Address - Fax:
Practice Address - Street 1:175 GWINNETT DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8444
Practice Address - Country:US
Practice Address - Phone:404-209-2394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95178036163W00000X
CT10.173173163W00000X
NC296511163WM0705X, 163WP0807X
CA95025461363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent