Provider Demographics
NPI:1205288321
Name:CASTELLANO, JOCELYN (NP)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:CASTELLANO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 LAWRENCEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3227
Mailing Address - Country:US
Mailing Address - Phone:770-934-6832
Mailing Address - Fax:770-934-6337
Practice Address - Street 1:2536 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3227
Practice Address - Country:US
Practice Address - Phone:770-934-6832
Practice Address - Fax:770-934-6337
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN210714363LP2300X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003179496AMedicaid