Provider Demographics
NPI:1649875311
Name:MEJIA, JOSE DANNYLO JR (FNP)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:DANNYLO
Last Name:MEJIA
Suffix:JR
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:143 GRACE VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-4947
Mailing Address - Country:US
Mailing Address - Phone:706-970-1222
Mailing Address - Fax:
Practice Address - Street 1:77 WEAVER RD STE B
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3136
Practice Address - Country:US
Practice Address - Phone:706-439-6165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN187555363L00000X, 363LF0000X
GAF10200522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner