Provider Demographics
NPI:1649634015
Name:MCEWEN, JAKAI NOLAN (DO)
Entity type:Individual
Prefix:
First Name:JAKAI
Middle Name:NOLAN
Last Name:MCEWEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 ATLANTA RD SE STE 150
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3856
Mailing Address - Country:US
Mailing Address - Phone:404-383-0845
Mailing Address - Fax:
Practice Address - Street 1:3016 ATLANTA RD SE STE 150
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-3856
Practice Address - Country:US
Practice Address - Phone:404-383-0845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0142952084N0400X
GA897032084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0409731Medicaid