Provider Demographics
NPI:1700507183
Name:JEWELL, ALICIA KATHERINE (NP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:KATHERINE
Last Name:JEWELL
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 1:207 TOWERING PEAKS
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5709
Mailing Address - Country:US
Mailing Address - Phone:313-300-7529
Mailing Address - Fax:
Practice Address - Street 1:793 SAWYER RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-2222
Practice Address - Country:US
Practice Address - Phone:470-644-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN271254363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily