Provider Demographics
NPI:1841363488
Name:JEFFERSON, JANICE M (BSN MA)
Entity type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:M
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:BSN MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 JESSE HILL JR DRIVE SE
Mailing Address - Street 2:ROOM 402
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315
Mailing Address - Country:US
Mailing Address - Phone:404-370-1217
Mailing Address - Fax:
Practice Address - Street 1:1853 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315
Practice Address - Country:US
Practice Address - Phone:404-624-0626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN040631163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner