Provider Demographics
NPI:1255784617
Name:THREATT, JAMIE LYALL (DNP, AGACNP-BC)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LYALL
Last Name:THREATT
Suffix:
Gender:F
Credentials:DNP, AGACNP-BC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LEE
Other - Last Name:LYALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:960 JOHNSON FERRY ROAD NE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-257-0006
Mailing Address - Fax:404-851-1316
Practice Address - Street 1:960 JOHNSON FERRY ROAD NE
Practice Address - Street 2:SUITE 500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-257-0006
Practice Address - Fax:404-851-1316
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN213384363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care