Provider Demographics
NPI:1205450475
Name:DAY, JEANNIE BERNICE
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:BERNICE
Last Name:DAY
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 1:940C GA HIGHWAY 96 STE C
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2502
Mailing Address - Country:US
Mailing Address - Phone:478-988-7100
Mailing Address - Fax:478-988-6847
Practice Address - Street 1:940C GA HIGHWAY 96 STE C
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-2502
Practice Address - Country:US
Practice Address - Phone:478-988-7100
Practice Address - Fax:478-988-6847
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN283166163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse